Urticaria Workup

Updated: Sep 16, 2020
  • Author: Henry K Wong, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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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]



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]