6
Î The co-occurrence of CU with a number of conditions, including
H. pylori infection and celiac disease, has been reported.
However, evidence does not support testing for these conditions
in a patient with CU with an otherwise unremarkable history
and physical examination. Moreover, there are no convincing
data demonstrating that treatment based on abnormal test
results consistent with these conditions being present leads to
improvement or change in the course of CU. (C)
Î Malignancies, such as lymphoproliferative diseases and Schnitzler
syndrome, can present with CU. (C)
Î Approximately 30%–50% of patients with CU produce specific IgG
antibodies against the FcεR1α subunit component of the high-
affinity IgE receptor. (C)
Î The utility of the autologous serum skin test (ASST) and autologous
plasma skin test (APST) is unclear because evidence has not
clearly demonstrated that this testing identifies a distinct
subgroup of patients with CU. Current evidence does not support
routine performance of ASSTs or APSTs in patients with CU. (C)
Î The pathogenesis of autoantibody-associated urticaria remains
elusive, but in vitro/ex vivo studies demonstrate a role for T cells,
sCD154 (sCD40 ligand), and basophil histamine responsiveness. (LB)
Î For patients with CU who present with an otherwise unremarkable
history and physical examination findings, skin or in vitro testing
for IgE to inhalants or foods and/or extensive laboratory testing
are NOT recommended because such testing is not cost-effective
and does not lead to improved patient care outcomes. (C)
• Targeted laboratory testing based on history or physical examination findings is
appropriate, and limited laboratory testing can be obtained. (E)
Î The initial patient evaluation should be focused to determine
(through history and physical examination) whether the lesions
that patients describe are consistent with CU. (D)
Î The medical work-up of a patient with CU should be done, keeping in
mind that CU is of undetermined cause in the majority of cases. (C)
Acute, Chronic and Physical Urticaria
and Angioedema
