Materiały źródłowe

• #1 Chronic hives – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-hives/diagnosis-treatment/drc-20352723

  To diagnose chronic hives, your healthcare professional will likely talk with you about your symptoms and look at your skin. One of the telling features of chronic hives is that the welts come and go at random, with each spot usually lasting less than 24 hours. […] You also may need blood tests to determine the cause of your symptoms. An accurate diagnosis will guide your treatment. If needed to clarify the diagnosis, your healthcare professional might do a skin biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab. […] For chronic hives, questions you may want to ask include: What kinds of tests do I need? Do these tests require any special preparation?

• #2 Hives: Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/8630-hives

  Hives, a skin rash thats often very itchy, often results from an allergic reaction to food or something youve touched. Hives can go away quickly (acute hives) or last a long time (chronic hives). Treatments may include antihistamines or steroids. […] Chronic urticaria refers to hives that happen at least twice a week for more than six weeks. […] Chronic, spontaneous urticaria is the name for chronic hives that dont have an obvious cause. An older name for this condition is chronic idiopathic urticaria. […] In many respects, chronic hives and acute hives may look alike: they can be itchy, swollen raised welts that turn lighter in the center and with pressure. However, chronic hives can: […] Unlike acute hives, chronic hives arent usually caused by allergies. They may be caused by infections from bacteria or viruses, or as a result of other medical conditions like lupus. Your provider may not discover an exact cause. In these cases, chronic hives are said to be idiopathic or spontaneous.

• #3 Diagnosing Chronic Idiopathic Urticaria (Hives)

  https://www.webmd.com/skin-problems-and-treatments/hives-diagnosis?page=3

  If you have hives that keep coming and going for weeks on end, and you dont know whats causing them, see a doctor. You could have what is called chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU). […] CIU is when a person has these breakouts almost daily for at least 6 weeks, with no known cause. […] If your doctor is able to rule out other conditions, they may refer you to a skin specialist or allergy specialist. […] If youre still having breakouts and the tests dont point to a cause, your doctor will most likely say you have CIU.

• #4 Evaluation, diagnosis and management of chronic urticaria

  https://www.racgp.org.au/afp/2014/september/evaluation-diagnosis-and-management-of-chronic-urt

  Chronic urticaria is characterised by the occurrence of weals, which occur on a daily basis for more than 6 weeks. Clinical history and physical examination alone are sufficient to establish a diagnosis. […] A detailed history is usually sufficient to establish a diagnosis of urticaria and the type of urticaria. Chronic urticaria persists for more than 6 weeks. […] In 80-90% of cases no identifying trigger for chronic urticaria can be established. However, it is thought that many of these idiopathic urticarias may be attributed to autoimmune causes. Chronic urticaria is associated with autoimmune disorders, most commonly hypothyroidism, but also coeliac disease, systemic lupus erythematosus (SLE) and type 1 diabetes mellitus. […] Diagnosis of chronic urticaria can be established with a history and physical examination.

• #5

  https://link.springer.com/article/10.1007/s40521-023-00333-w

  Urticaria is a frequent disorder that can present with erythema, edema, and pruritus involving the skin and mucous membranes. Early diagnosis and proper management of the urticaria according to the type (i.e., acute vs chronic) is of utmost importance to reduce the burden of the disease and prevent psychosocial comorbidities. […] In a patient with a clinical suspicion of urticaria, the first step is to classify it into AU (6 weeks) or CU (6 weeks). […] In CU, three elements are important in the diagnosis procedure. First, is to identify the elementary lesion that characterizes urticaria and urticarial rashes. Urticaria might present with hives (wheals) and/or angioedema, the latter involving the deeper mucocutaneous layers. […] The identification of the trigger or triggers should not be limited to environmental agents since the autoimmune nature of the disease, especially in chronic forms, plays an essential role. Thus, the diagnosis and management of urticaria cannot be limited to the symptomatic treatment of the symptoms using H1-antihistamines and other available drugs without first identifying the type of urticaria that the patient shows.

• #6 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Urticaria is caused by immunoglobulin E- and nonimmunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. Diagnosis is made clinically; anaphylaxis must be ruled out. Chronic urticaria is idiopathic in 80% to 90% of cases. […] The diagnosis of urticaria is usually clinical. The first step in evaluating urticaria and angioedema is a history and physical examination to characterize the lesions and help identify causes. […] Laboratory workup in the absence of indications of an underlying cause is not necessary. If the history or physical examination suggests a specific cause or underlying disease, targeted testing is appropriate. […] Methods of treatment for urticaria are the same for adults and children. The mainstay of treatment is avoidance of identified triggers.

• #7 Hives (Urticaria) and Angioedema Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/hives-(urticaria)-and-angioedema-overview

  Hives or welts, also known as urticaria, are itchy, raised, reddish areas on the skin. […] Doctors will classify your hives based on how long you have had them. This helps doctors think about possible causes of your hives. When hives occur for less than 6 weeks, we call this acute urticaria. When hives last longer than 6 weeks, we change the name to chronic urticaria. […] Sometimes chronic hives may be autoimmune in nature, or related to an autoimmune condition including autoimmune thyroid disease, rheumatoid arthritis or systemic lupus erythematousus. […] Antihistamines are frequently an effective form of treatment. […] About 50% of chronic spontaneous urticaria (hives over 6 weeks with no identifiable cause) will respond to antihistamine as discussed above. […] Omalizumab is an FDA approved treatment of chronic urticaria. This medication is injected under the skin once a month. […] Chronic hives can last for many years but will often go away. Hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years. Even if a patients hives improve, it is not unusual to see the hives recur months to years later.

• #8 How are Chronic Hives Diagnosed?Share to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on instagramFollow us on facebookFollow us on linkedincaret icon

  https://chronic-hives.com/diagnosis

  Diagnosing chronic hives is not always easy. This is because many other conditions cause hives. Also, the cause of chronic hives is usually unknown. Your doctor needs to rule out any other causes of your symptoms to help you manage and treat your hives. […] Many people with chronic hives experience a delay in diagnosis. During this time, doctors will use your health history and lab tests to determine a diagnosis. They may also refer you to specialists to help rule out other conditions. Usually, doctors use 3 things to diagnose chronic hives: Your health history, A physical exam, Identifying triggers that worsen or cause symptoms. […] A detailed history of your symptoms is the most important part of diagnosis. It may be helpful to use a diary to keep track of your symptoms, activities, and any triggers. Your doctor will ask about: Shape, size, and site of hives, Frequency, timing, and duration of hives, Whether you also have swelling under skin (angioedema), Family history of hives and swelling.

• #9 Chronic Spontaneous/Idiopathic Urticaria (Chronic Hives)

  https://acaai.org/allergies/allergic-conditions/skin-allergy/chronic-hives/

  Chronic hive symptoms are generally the same as “short-lived” hive symptoms but appear at least twice a week and last more than six weeks. […] Chronic hives should be evaluated by an allergist, who will ask about your and your family’s medical history, substances to which you are exposed at home and at work, and any medications you’ve taken recently. […] Patients with CSU/CIU often believe that their condition is due to food allergies, but it’s been established that, for almost all patients with this disorder, the condition is not triggered by foods.

• #10 Testing for Hives (Urticaria): Getting a Diagnosis

  https://www.health.com/hives-diagnosis-7092859

  Hives, also known as urticaria, is an inflammatory skin condition characterized by red or skin-colored welts on the body. Proper diagnosis of hives is essential for the medical management of this condition, which may be treated by a primary care physician, dermatologist, allergist, or another healthcare provider. This typically involves a physical examination and an assessment of medical history. Additional tests may be needed for confirmation and to determine the severity and type of urticaria. […] The first step of diagnosis typically involves a thorough and comprehensive evaluation of your medical history and status. The healthcare provider will ask about the size, shape, and location of the bumps (called weals) as well as any larger areas of swelling, how long you’ve been experiencing symptoms, how severe your symptoms are and any other unusual signs you’re experiencing, any prescribed or over-the-counter medications you’re taking, especially nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and hormone therapies, any recent travel you’ve done, any other medical or skin conditions you’ve had, personal or family history of allergies or allergic disorders, sexual health and any sexually transmitted infections (STIs), signs of underlying diseases, such as fever, weight loss, joint stiffness, arthritis, abdominal pain, bone pain, and heat or cold sensitivity, and any bug bites or bee stings.

• #11 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  In most cases of chronic hives, the cause is unknown. Researchers suspect that problems in the immune system play a role. […] Hives can be a sign of several other medical or autoimmune conditions, including thyroid or liver diseases, chronic infections, or lupus. Most people with one of these conditions will have other symptoms apart from hives.

• #11 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  HIVES TESTING […] Most people with hives do not need any testing. The diagnosis is usually based on their symptoms and a physical examination. However, tests may be recommended if hives do not resolve within six weeks. […] […] Testing — Skin testing for food and drug sensitivities may be recommended if there are concerns about allergies as a cause of symptoms. This is usually done for people with acute hives. Chronic hives are rarely caused by an allergy. […] […] Blood tests are sometimes done if hives continue for six weeks or longer. Blood tests can tell if there are signs of underlying diseases, such as thyroid problems or an autoimmune disease. […] […] Skin biopsy — A skin biopsy (when a small sample of skin is removed) may help identify uncommon causes of hives. A skin biopsy may be recommended for people who have chronic hives along with other symptoms, such as persistent fever, painful hives, individual hives that last for days at a time, or hives associated with bruising of the skin. A skin biopsy may also be recommended for people who have other symptoms or abnormal blood tests.

• #12 Testing for Hives (Urticaria): Getting a Diagnosis

  https://www.health.com/hives-diagnosis-7092859

  Following a discussion of your symptoms, your healthcare provider will perform a physical exam for your condition. They will look for any symptoms on your eyes, ears, nose, throat, lymph nodes, abdomen, and musculoskeletal system. This is critical for ensuring that symptoms are indeed those of hives and not of other conditions. […] Blood tests may be another step for confirming a diagnosis of urticaria. Your healthcare provider will take your blood sample and send it to a lab for testing. Blood tests are generally indicated for chronic cases in which symptoms persist longer than six weeks. […] The diagnosis of urticaria, commonly called hives, primarily involves an assessment of medical history, as well as a physical examination of affected areas. In chronic cases, additional tests may be needed. These include allergy tests, blood tests, as well as tests to identify any triggers for urticaria. In some cases, an evaluation will also be needed to screen for other conditions that may be causing the symptoms, or those that accompany the issue.

• #13 Diagnosis and treatment of urticaria in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6526977/

  Urticaria, also known as hives among people, is a very common disease characterized by erythematous, edematous, itchy, and transient plaques that involve skin and mucous membranes. […] The diagnosis is usually straightforward, urticarial vasculitis, drug eruptions, viral eruptions, and urticaria pigmentosa must also be considered. […] It is quite easy to diagnose based on clinical appearance and anamnesis. However, it is also sometimes confused with drug eruptions, viral rashes, connective tissue diseases, photosensitive diseases, urticaria pigmentosa, urticarial vasculitis, and a number of syndromic diseases. […] There is no need for routine laboratory tests and allergy tests in acute urticaria. In a guideline published in the United States, it has been reported that if there is no evidence to support a diagnosis, then there is no need for laboratory examinations. […] Just 25% of acute urticaria cases become chronic in time.

• #14 Urticaria (Hives): a complete overview — DermNet

  https://dermnetnz.org/topics/urticaria-an-overview

  Chronic urticaria may be spontaneous or inducible. Both types may co-exist. […] Chronic spontaneous urticaria affects 0.52% of the population; in some series, two-thirds are women. Chronic inducible urticaria is however more common. There are genetic and autoimmune associations. […] Chronic spontaneous urticaria is mainly idiopathic (cause unknown). An autoimmune cause is likely. About half of investigated patients carry functional IgG autoantibodies to immunoglobulin IgE or high-affinity receptor FcRI. […] There are no routine diagnostic tests in chronic spontaneous urticaria apart from blood count and C-reactive protein (CBC, CRP), but investigations may be undertaken if an underlying disorder is suspected. […] Patients with chronic urticaria that has failed to respond to maximum-dose second-generation oral antihistamines taken for four weeks should be referred to a dermatologist, immunologist or medical allergy specialist.

• #15 Chronic spontaneous urticaria: Clinical manifestations, diagnosis, pathogenesis, and natural history – UpToDate

  https://www.uptodate.com/contents/chronic-spontaneous-urticaria-clinical-manifestations-diagnosis-pathogenesis-and-natural-history

  Chronic spontaneous urticaria (CSU) is defined by the presence of recurrent urticaria (also called hives or wheals), angioedema, or both for a period of six weeks or longer. […] The clinical manifestations, epidemiology, diagnosis, theories of pathogenesis, and natural history of CSU will be reviewed here. […] The term „chronic spontaneous urticaria” (CSU) refers to patients with recurrent urticaria for six weeks or longer, as well as those with both urticaria and angioedema. […] There are additional diagnostic considerations in patients with isolated angioedema, which are discussed in more detail separately. […] The term „spontaneous” is included to differentiate CSU from several forms of inducible urticaria, which are hives triggered by physical stimuli, such as heat, cold, pressure applied to the skin, exercise, water, vibration, and sunlight. […] Other terms for CSU include „chronic idiopathic urticaria” and the general term „chronic urticaria.”

• #16 Diagnosis of urticaria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3667285/

  Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism. […] Diagnostic procedures in CsU are performed to characterize possible underlying causes, as eliminating them will cure patients. In up to 80% of patients, one or more of the following most common causes of CsU can be found: (i) auto-reactivity (ii) infection, and (iii) intolerance. […] A search for possible underlying causes and/or relevant triggers should be conducted especially, in patients who present with relapsing symptoms for more than 1 year and/or with high disease activity. CsU disease activity can be evaluated using the urticaria activity score (UAS), which is a clinical symptom score that combines daily recordings of the numbers of wheals and the intensity of pruritus.

• #17 Chronic Urticaria Workup: Laboratory Studies, Other Tests, Histologic Findings

  https://emedicine.medscape.com/article/1050052-workup

  The information elicited from the history and physical examination is used to direct the selection of laboratory tests. While in most cases no diagnostic testing may be necessary, targeted laboratory testing based on clinical suspicion is appropriate. In most patients, the only screening tests that are recommended to be performed are a complete blood cell (CBC) count with differential, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), liver enzymes, and thyrotropin (TSH). […] The ESR may be elevated in persons with urticarial vasculitis. Antinuclear antibody (ANA) titers are indicated when urticarial vasculitis is suspected. ESR, CRP, ANA, and rheumatoid factor (RF) testing should be performed if additional features of an underlying rheumatologic disorder are found. […] Thyroid function testing and antithyroid microsomal and peroxidase antibody titers may also be useful. Patients with urticaria unresponsive to antihistamines or steroids may have elevated titers, which may respond to thyroid hormone therapy.

• #18 Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1078.html

  Urticaria involves intensely pruritic, raised wheals, with or without edema of the deeper cutis. […] Diagnosis is made clinically. Chronic urticaria is usually idiopathic and requires only a simple laboratory workup unless elements of the history or physical examination suggest specific underlying conditions. […] An extensive workup is not recommended for diagnosing a cause of chronic urticaria. Additional testing can be done if presentation suggests underlying disease or specific causes requiring confirmation. […] A broad laboratory workup has not been found to increase the likelihood of diagnosing a cause of urticaria. […] For instance, presentation suggestive of urticarial vasculitis should prompt immediate biopsy. […] With chronic urticaria, all of the guidelines reviewed for this article recommend a complete blood count with differential and measurement of erythrocyte sedimentation rate or C-reactive protein level to test for infection, atopy, and systemic illness, whereas measurement of thyroid-stimulating hormone level, liver function tests, and urinalysis are variously recommended.

• #19 Chronic Spontaneous Urticaria Is Not an Allergic Process: The Limited Value of Extensive Testing

  https://themedicalxchange.com/en/2020/02/06/3012-chronic-spontaneous-urticaria-is-not-an-allergic-process-the-limited-value-of-extensive-testing/

  In patients with the clinical features of chronic urticaria, diagnostic tests, including skin tests for allergens, are not a standard of care. […] Rather, the diagnosis of chronic urticaria can and should be based primarily on history and physical examinations. […] CSU can and should be diagnosed in the primary care setting, where the initiation of first-line therapies is appropriate. Specialist referrals for CSU patients inadequately controlled on first-line therapies should be for the purpose of advanced care instead of additional testing. […] Diagnostic studies beyond a history or physical are discouraged. They threaten prompt treatment with limited potential to improve treatment choices or outcomes. […] In practical terms, the diagnosis of CSU is an empirical process based on exclusion. Although there are no biomarkers or definitive tests to establish CSU, patients can be reassured of the diagnosis when symptoms are skin related in the absence of systemic involvement. […] Diagnostic studies beyond a history or physical are discouraged. They threaten prompt treatment with limited potential to improve treatment choices or outcomes.

• #20 Diagnosis, Severity, and Impact of Chronic Spontaneous Urticaria

  https://www.dermatologytimes.com/view/diagnosis-severity-and-impact-of-chronic-spontaneous-urticaria

  Patients with CSU can experience an average delay of 24 months from symptom onset to the time a diagnosis is established. […] A thorough history and a physical exam is usually the first step in ensuring an accurate diagnosis of CSU. […] There is a CSU diagnostic algorithm that is available, and this tool allows physicians to explore the multiple pathways that can lead to a diagnosis of CSU and also exclude other differential diagnoses. […] Diagnostic testing for CSU beyond basic lab tests such as a CBC with differential, an ESR, or a CRP should be limited to patients with atypical findings. […] Skin biopsies should be performed only when hives last for more than 24 hours and where we suspect a diagnosis of urticarial vasculitis.

• #21 Chronic urticaria

  https://dermnetnz.org/topics/chronic-urticaria

  Chronic urticaria is diagnosed in people with a long history of daily or episodic weals that last less than 24 hours, with or without angioedema. A medication and family history should be elicited. A thorough physical examination should be undertaken to evaluate the cause. […] Inducible urticaria is often confirmed by inducing the reaction, such as scratching the skin in dermographism or applying an ice cube in suspected cold urticaria. […] Suggested investigations for chronic spontaneous urticaria: Full blood examination, ESR or C-reactive protein, Liver enzymes, Renal function, Thyroid test – TSH. […] Further investigations should only be undertaken if an underlying disorder is suspected on history and examination. […] The autologous serum skin test is sometimes carried out in chronic spontaneous urticaria, but its value is uncertain. It is positive if an injection of the patient’s serum under the skin causes a red weal. […] Biopsy of urticaria can be non-specific and difficult to interpret. The pathology shows oedema in the dermis and dilated blood vessels, with a variable mixed inflammatory infiltrate. Vessel-wall damage indicates urticarial vasculitis.

• #22

  https://link.springer.com/article/10.1007/s13555-024-01173-5

  Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition characterized by the spontaneous onset of itchy wheals, angioedema, or both, which occurs for longer than 6 weeks overall. […] Despite the relatively straightforward diagnostic algorithm for CSU, relying primarily on a detailed medical history and only limited laboratory tests, patients often wait years to be diagnosed, with many cycling through different healthcare practitioners before a diagnosis is made. […] Diagnosis is straightforward, based primarily on patient history and self-reporting. Only basic laboratory tests are required. […] The recently published international EAACI/GA2LEN/EuroGuiDerm/APAAACI urticaria guideline provides an evidence-based diagnostic algorithm for CSU. […] The essential steps in the diagnostic and prognostic workup of patients with suspected CSU comprise: (1) a comprehensive medical history; (2) physical examination; (3) basic tests, i.e., differential blood count, C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), and, for patients under specialist care, total IgE and IgG anti-TPO; and (4) assessment of disease activity, impact on QoL, and disease control, utilizing patient-reported outcome measures.

• #23 Keys to Diagnosis of Urticaria | MedPage Today

  https://www.medpagetoday.com/medical-journeys/urticaria/108964

  For patients with chronic urticaria, which is classified by the presence or absence of definite triggering factors, the guideline-recommended third step is a basic diagnostic work-up. Chronic spontaneous urticaria (CSU) accounts for 60-90% of chronic urticaria but has no definite triggers, while chronic inducible urticaria has definite, subgroup-specific triggers, such as cold, heat, and pressure. […] In patients with CSU, the guideline recommends a differential blood count and C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), with a total IgE with IgG-anti-thyroid peroxidase in those under the care of a specialist. […] The goal of any diagnostic test should be clear to both physician and patient, the guideline authors emphasized. […] The value of these tests is debatable, said Silverberg, adding that the test results are unlikely to impact either the choice of therapy or its effectiveness.

• #24 Hives: Diagnosis and Treatment | Oak Brook Allergists

  https://www.oakbrookallergists.com/2020/11/27/hives-diagnosis-and-treatment/

  An allergist can take one look at the spots on your skin and make a diagnosis just based on their appearance. […] Your allergist will first review your medical history and then perform tests to diagnose hives. These tests may include an allergy blood test and a skin-prick test. To identify the cause of hives usually involves a combination of diagnostic testing and detective work. A blood test is used to check for the presence of specific antibodies in your blood; in a skin test, the doctor tests different allergens on your skin and looks for an allergic reaction.

• #25 Diagnosis of urticaria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3667285/

  CsU due to auto-reactivity is diagnosed by use of the Autologous Serum Skin Test (ASST). Detailed recommendations on how to perform and assess the ASST have recently been published. […] In vitro basophil histamine release assays are useful for confirming CsU due to auto-reactivity and may be performed, together with IgE- and FcRI-antibody assays, to identify those patients with CsU due to auto-reactivity who suffer from autoimmune CsU.

• #26 A Diagnosis of Urticaria, Common Skin Condition | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/urticaria-diagnosis/

  The autologous serum skin test (ASST) and the autologous plasma skin test (APST) indicating CSU are useful to diagnose autoimmune chronic urticaria. […] The negative result of ASST and APST before treatment served as a predictor of good prognosis treatment and urticaria remission during a 2-year observational study. […] No specific laboratory test can be used to monitor urticaria activity. Disease activity in CSU can be accessed by an urticaria activity score for 7 days or an urticarial control test.

• #27 Chronic Urticaria Workup: Laboratory Studies, Other Tests, Histologic Findings

  https://emedicine.medscape.com/article/1050052-workup

  The Chronic Urticaria (CU) Index is not widely available and is only performed at a few reference laboratories. Patients with a chronic form of urticaria who have a positive functional test result for autoantibody to the Fc receptor of IgEthat is, anti-FcRlikely have an autoimmune basis for their disease. […] Although histologic examination is not necessary for the diagnosis of urticaria, a skin biopsy is necessary for the diagnosis of urticarial vasculitis or a neutrophil-predominant pattern of urticaria that may not respond well to antihistamines. A skin biopsy is indicated for patients in whom individual urticarial lesions persist for more than 24 hours or are associated with petechiae or purpura and for patients with systemic symptoms such as fever, arthralgia, or arthritis.

• #28 Diagnosis and Management of Chronic Idiopathic Urticaria

  https://practicingclinicians.com/the-exchange/diagnosis-and-management-of-chronic-idiopathic-urticaria

  Chronic idiopathic urticaria (CIU), also called chronic spontaneous urticaria (CSU), is a condition when urticaria, or hives, are present for more than 6 weeks. […] The diagnosis of CSU is clinical. It requires at least 6 weeks of pruritus, as well as red, raised, and well-circumscribed lesions that vary in size and location. […] Routine laboratory evaluation for CSU, in absence of other symptoms, is not indicated. […] If there is associated bruising or skin changes, skin biopsy should be completed to assess for vasculitis. […] Overall, proper identification and treatment of CSU can eliminate unnecessary testing, patient anxiety, and reduce healthcare costs. Further, by following established treatment guidelines, patients with CSU will have improved clinical outcomes.

• #29 Chronic Urticaria Differential Diagnoses

  https://emedicine.medscape.com/article/1050052-differential

  A potential diagnostic pitfall is the failure to consider a diagnosis of urticarial vasculitis in patients with lesions lasting longer than 24 hours, in patients with lesions associated with pain more than with itching, and in patients with lesions resolving with pigmentary changes or scaling. […] In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following: Chronic infantile neurologic cutaneous articular syndrome, Familial cold autoinflammatory syndrome, Melkersson-Rosenthal syndrome, Muckle-Wells syndrome, Reticular erythematosus mucinosis. […] Differential diagnosis of chronic urticaria.

• #30 How are Chronic Hives Diagnosed?Share to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on instagramFollow us on facebookFollow us on linkedincaret icon

  https://chronic-hives.com/diagnosis

  Many conditions are easy to confuse with chronic hives. The 2 most similar conditions are urticarial vasculitis (blood vessel inflammation) and mastocytosis (too many mast cells in the body). However, your doctor and specialists can rule out these conditions based on descriptions of your hives. […] Your primary care doctor may be able to diagnose hives themself. But in some cases, they may need to refer you to a specialist. Some situations when you may need to see a specialist include: When they suspect an underlying disorder, If you have signs or symptoms of urticarial vasculitis. […] In these situations, you may have to see a dermatologist or an allergist/immunologist. These are doctors who can perform more detailed tests for skin and allergic conditions.

• #31 Chronic spontaneous urticaria: clinical features, diagnosis and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/chronic-spontaneous-urticaria-clinical-features-diagnosis-and-management

  Following diagnosis of CSU, the following validated scales are used to assess its severity and impact on QoL: Urticaria activity score 7 (UAS7), Angioedema activity score (AAS), Urticaria control test (UCT). […] Currently there is no curative treatment for CSU, therefore, treatment aims to improve or suppress symptoms by inhibiting the release and/or the effect of mast cell mediators. […] Pharmacists are best placed to provide additional support in the identification and management of CSU.

• #32 Chronic Spontaneous Urticaria – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/skin-allergy/urticaria-hives-chronic

  Chronic spontaneous urticaria (CSU) is the name for hives (urticaria) that are chronic, lasting six weeks or more, three to four times per week, and have no known cause (spontaneous). […] CSU is diagnosed when a person develops hives lasting for more than six weeks, without an allergic cause. To confirm this diagnosis, your doctor will: Review medical history and give a physical examination. Keeping a diary of symptoms with a photographic record of hives can be very helpful for this. Order blood tests if an underlying condition is suspected. Allergy tests are usually not required unless there is a reason to suspect an allergic cause.

• #33 Hives | Hives Diagnosis

  https://resources.healthgrades.com/right-care/allergies/why-chronic-hives-are-difficult-to-diagnose

  Many people develop hives, also known as urticaria, as a result of exposure to allergens. […] But diagnosing chronic, or long-term, hives can be difficult, leading to frustration for both you and your doctor. […] Working with your dermatologist or allergist is the best way to arrive at an accurate diagnosis. […] Typically, doctors consider a diagnosis of chronic hives if the hives have been present for six weeks or longer without disappearing completely. […] Because we don’t know the exact cause of chronic hives, and because many other conditions can cause similar welts to develop, your dermatologist or allergist may recommend several diagnostic tests to rule out other diseases and identify any underlying medical problems. […] The diagnostic tests may include blood work to monitor inflammation levels and help identify allergens that may cause your symptoms. […] Although it can take time to reach a chronic hives diagnosis, it’s crucial to take each step in order to get an accurate assessment of your condition. […] Because chronic hives often have no identifiable cause, diagnosing this condition can be difficult.

• #34 Chronic Spontaneous Urticaria (CSU) | Novartis U.S.

  https://www.novartis.com/us-en/patients-and-caregivers/diseases/chronic-spontaneous-urticaria

  Chronic spontaneous urticaria (CSU) is a serious condition that affects approximately 1.7 million people in the United States and is characterized by itchy hives, deep tissue swelling (angioedema), or both for more than 6 weeks. […] As an immune-related condition, CSU is driven by mast cells and other internal mechanisms rather than external factors such as triggers, which can make diagnosis and treatment challenging. […] While it may be necessary to run tests to help rule out other conditions, there is no one biological marker for diagnosing CSU, so diagnosis relies primarily on physical examinations and tracking symptoms. […] By the time a patient has been diagnosed with CSU, they have likely gone through extensive testing and lifestyle changes in hopes of improving their symptoms without finding relief. […] In fact, it can sometimes take around two years to get a diagnosis or treatment for CSU, and once diagnosed, approximately half of patients remain symptomatic despite taking increased doses of antihistamines.

• #35

  https://link.springer.com/article/10.1007/s13555-024-01173-5

  There is a lack of distinguishing diagnostic biomarkers for CSU. […] It is important to differentiate urticaria from other conditions that can manifest with wheals and/or angioedema but have distinct pathophysiology and/or clinical presentation. […] Adherence to best-practice guidelines is fundamental for improving treatment outcomes in CSU.

• #36 How are Chronic Hives Diagnosed?Share to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on instagramFollow us on facebookFollow us on linkedincaret icon

  https://chronic-hives.com/diagnosis

  If your symptoms are consistent with chronic hives, doctors will ask questions to identify possible causes. The goal is to make sure you do not have a more serious condition, such as an autoimmune disorder. […] Usually, your doctor can distinguish chronic hives from similar conditions based on a detailed description of your symptoms. […] Once doctors rule out these causes, there is a high chance you have chronic idiopathic hives. This means that no cause can be identified. […] There is no single test that gives your doctor a definite answer about whether or not you have chronic hives. Doctors may perform a number of tests to rule out other conditions. […] Once the results come back, your doctor uses them, along with your health history and physical exam, to make a diagnosis. […] The time from when symptoms begin to diagnosis varies for each person. Diagnosis can take as short as a couple of weeks or as long as several years. A proper diagnosis may be delayed because of several factors, including: Lack of awareness about chronic hives, Uncertainty about conditions with no known cause, Symptoms that come and go, Time spent ruling out other conditions.

• #37 Chronic Spontaneous Urticaria: Diagnosis and Treatment Strategies

  https://www.dermatologytimes.com/view/chronic-spontaneous-urticaria-diagnosis-and-treatment-strategies

  Dr Rodrigues discussed the characteristics of CSU, which are wheals (or hives) and/or angioedema present for more than 6 weeks. […] Accurately diagnosing CSU involves a thorough history and physical examination. In addition to assessing the presence of wheals or hives and angioedema, providers should also review family history and all patient symptoms to rule out other possible conditions. There is a CSU diagnostic algorithm, shared Dr Rodrigues. This tool allows physicians to explore the multiple pathways that can lead to a diagnosis of CSU and also exclude other differential diagnoses. […] Delayed diagnosis is common among patients with CSU, who experience an average delay of 24 months from symptom onset to established diagnosis. […] Overall, insufficient knowledge of CSU among health care providers in both primary and secondary care can contribute to diagnostic delays.

• #38 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  If antihistamines alone do not help your chronic hives, your doctor may recommend you combine it with other medications. […] Omalizumab (Xolair) is a biologic medication used to treat chronic hives. […] When chronic urticaria symptoms do not respond to antihistamines or omalizumab, then your doctor may recommend cyclosporine as the next step. […] Light therapy, also known as phototherapy, is a treatment option for very severe hives. […] Chronic urticaria is a frustrating and uncomfortable condition. But thankfully it’s not a life-threatening condition. Treatment with antihistamines or other medications will usually clear up symptoms. But chronic urticaria can have a significant impact on a person’s quality of life. […] About 30-40% of chronic urticaria cases are related to an autoimmune condition and can be considered autoimmune urticaria. […] If your chronic urticaria symptoms are severe enough, you may qualify for a disability and you may be eligible for benefits.

• #39 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated, such as hydroxyzine or the tricyclic antidepressant doxepin. The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] Acute urticaria is typically self-limited and resolves with proper avoidance of triggers. With chronic urticaria, a prospective cohort study found that 35% of patients are symptom free within one year, with another 29% having some reduction of symptoms.

• #40 Hives (Urticaria) | Causes, Symptoms & Treatment

  https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/

  Chronic hives occur almost daily for more than six weeks and are typically itchy. Each hive lasts less than 24 hours. They do not bruise nor leave any scar. They typically do not have an identifiable trigger. […] If your hives last more than a month or if they recur over time, see an allergist, who will take a history and perform a thorough physical exam to try and determine the cause of your symptoms. A skin test and challenge test may also be needed to identify triggers. […] Chronic hives should be evaluated by an allergist, who will ask about your and your family’s medical history, substances to which you are exposed at home and at work, exposure to pets or other animals and any medications you’ve taken recently. […] Your allergist may want to conduct skin tests, blood tests and urine tests to identify the cause of your hives.

Zobacz więcej