Chronic urticaria (spontaneous / inducible)

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: EB00.1

1/23

Recurrent urticaria episodes lasting longer than 6 weeks.

  • Prevalence: approx. 1% of the population
  • Women: Men = 2: 1

Chronic urticaria: differentiation according to aetiology.

  • Chronic spontaneous urticaria (CSU):
  • Chronic inducible urticaria:
    • Physical urticaria (pressure, vibration)
    • Cold urticaria
    • Heat urticaria
    • Light urticaria
    • Cholinergic urticaria
    • Autoimmune urticaria
    • Aquagenic urticaria
    • Exertional urticaria
    • Contact urticaria
      • Allergic
      • Non-allergic

S. Urticaria.

Stage 1

Medical history

Personal and family history for atopy, medication history (especially: ASA,

NSAIDS, β-blockers, ACE inhibitors, histamine ligators).

Frequency

Duration

Dependent on time of day?

Localisation?

Infections?

FA: Atopy? Urticaria?

Nicotine or alcohol abuse?

Is there angioedema?

Incompatibilities?

Physical stimuli?

Occupation?

Hobbies?

New implants?

Insect bites?

Association with menstrual cycle?

Previous therapies?
Status

Quaddling?, petechiae, hyperpigmentation?

Dermographism?, Darier?

In isolated urticaria factitia: no further investigations
Laboratory

Blood count diff, CRP,TSH, fT4

Thyroid autoantibodies (anti-TPO, anti-TG, TRAK), ANA

Tryptase, IgE total, ev. Fx5
Skin testing Atopiescreening
Stage 2: according to history

Angioedema without urticaria		 C1 inhibitor concentration, function, C4
Vd. a. Food allergy (rare)

allergological clarification:

skin testing, CAP, oral provocation testing (OPT)
Increase in intake of histamine-rich food low-histamine diet with nutritional counselling, complaints diary
Anamnestically unclear connection with food intake

Ev. Rice-potato diet (ev inpatient)

If improvement, try low additive diet

V.a. physical urticaria:

Cold urticaria Heat urticaria Pressure urticaria

Cholinergic urticaria Light urticaria

Aquagenic urticaria

Cold test

Heat test

Pressure test

Bicycle ergometer

UV threshold

Water test
V.a. autoreactive urticaria autologous serum test
V.a. Hepatitis Hepatitis serology, ev cryoglobulinaemia

Reflux, stomach pain

H. pylori breath test

Systemic symptoms (fever, arthral-gia, etc)

V.a. Schnitzler's syndrome (rare)

Cryopyrin-associated periodic

syndromes (rare)

Biopsy (neutrophilic urticaria?)

Immunelectrophoresis, immunofixation

Ev. NLRP3 gene mutation search, measure IL-6 in relapse
Quaddles >24h/ hyperpigmentation/petechiae, resistance to therapy Biopsy, ev. DIF, C3,C4
Darier's sign positive Biopsy (mast cell stain)
ANA increased

≤1:80 no further work-up

1:160 Follow-up

≥ 1:320 ANA specificities (depending on clinic and binding pattern)
Depending on sexual history HIV-Test
CRP↑ or leucocytosis Focus search according to history

Eosinophilia or IgE↑ or

tropical stay		 Stool examination + serology
V.a. Early stage bullous

pemphigoid		 Biopsy with DIF, IIF in serum

  • Recording of suffering pressure by means of PRISM and quality of life questionnaire (CU-QoL).
  • Recording of urticaria activity by means of UAS-7 diagnostics.
  • According to guidelines, exclusion of malignant diseases is obsolete.

S. Urticaria.

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