Approach Considerations

A thorough medical history, review of systems, and physical examination are warranted in order to exclude chronic autoimmune disease or underlying malignancy such as lymphoma.

Laboratory Studies

For acute urticaria, laboratory studies generally are not indicated. The patient's history and physical examination should direct any diagnostic studies.

For chronic or recurrent urticaria, basic laboratory studies should be prompted by signs and symptoms but may include a CBC count, erythrocyte sedimentation rate, thyroid-stimulating hormone value, and an antinuclear antibody level looking for possible causes of the urticaria.^[4]There may be benefit to radioallergosorbent, scratch, or patch testing.^[37]

Imaging Studies

Imaging studies generally are not indicated unless a specific finding on clinical examination or history suggests an underlying etiology that may warrant further diagnostic studies.^[4]

Procedures

Biopsy is generally not required for the diagnosis of classic urticaria (hives). However, if urticarial vasculitis is suspected (urticaria lasting >24 h with residual dyspigmentation; significant pain as well as pruritus), a punch biopsy of the lesion should be performed and sent to the pathology laboratory to look for leukocytoclastic vasculitis.^[9]

Treatment & Management

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Media Gallery

Urticaria developed after bites from an imported fire ant.
Urticaria associated with a drug reaction.

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Author

Henry K Wong, MD, PhD Professor and Chairman, Department of Dermatology, University of Arkansas for Medical Sciences College of Medicine

Henry K Wong, MD, PhD is a member of the following medical societies: American Academy of Dermatology, International Society for Cutaneous Lymphomas, Medical Dermatology Society, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Seattle Genetics, Actillion, Celgene, Kyowa-Kirin<br/>Serve(d) as a speaker or a member of a speakers bureau for: Amgen<br/>Received income in an amount equal to or greater than $250 from: Celgene<br/>Received honoraria from Amgen for speaking and teaching; Received grant/ Received grant/research funds from Celgene for none; Received grant/research funds from Abbott Labs for independent contractor; Received grant/research funds from Amgen for none; Received honoraria from Seattle Genetics for consulting. for: Actelion-Advisory board, grants;Seattle Genetics - Advisory board.

Coauthor(s)

Mallory Shiver, MD Resident Physician, Department of Dermatology, University of Arkansas for Medical Sciences College of Medicine

Mallory Shiver, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Arkansas Foundation for Skin Cancer, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Steven A Conrad, MD, PhD Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Mark W Fourre, MD Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; Program Director, Department of Emergency Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

Urticaria Workup

Approach Considerations

Laboratory Studies

Imaging Studies

Procedures

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