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Table 2. Guidelines for Diagnostic Work-up of Patients with CU
History and physical examination
• Onset (e.g., timing of symptoms with any change in medication or other exposures)
• Frequency, duration, severity, and localization of wheals and itching
• Dependence of symptoms on the time of day, day of the week, season, menstrual
cycle, or other pattern
• Known precipitating factors of urticaria (e.g., physical stimuli, exertion, stress, food,
or medications)
• Relation of urticaria to occupation and leisure activities
• Associated angioedema or systemic manifestations (e.g., headache, joint pain, or
gastrointestinal symptoms)
• Known allergies, intolerances, infections, systemic illnesses, or other possible causes
Family history of urticaria and atopy
• Degree of impairment of quality of life
• Response to prior treatment
• Physical examination
Laboratory evaluation
• Routine evaluation: Testing should be selective. There is an honest difference of
opinion concerning the appropriate tests that should routinely be performed for
patients with CU in the absence of etiologic considerations raised by a detailed
history and careful physical examination.
• A majority of members of the Practice Parameters Task Force expressed a
consensus for the following routine tests in managing a patient with CU without
atypical features:
The utility of performing these tests routinely for patients with CU has not been
established.
▶ CBC with differential
▶ Erythrocyte sedimentation rate, C-reactive protein level, or both
▶ Liver enzymes
▶ TSH
• Additional evaluation might be warranted based on patients' circumstances
and might include, but is not be limited to, the diagnostic tests listed below.
A thorough history and meticulous physical examination are essential for
determining whether these additional tests are appropriate:
▶ Skin biopsy
▶ Physical challenge tests
▶ Complement system (e.g., C3, C4, and CH
50
)
▶ Stool analysis for ova and parasites
▶ Urinalysis
Acute, Chronic and Physical Urticaria
and Angioedema
