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Urticaria

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8 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

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