Content on this page:
Content on this page:
Clinical Presentation
Diagnosis of urticaria is based on the patient’s history and physical examination.
History
In history taking, identify the etiology of the hives. Patients with chronic urticaria may present with rhinorrhea, dyspnea, hypertension, gastritis, joint pain, fatigue, anxiety and depression. History of angiotensin-converting enzyme (ACE) inhibitor treatment and other cardiac or antidiabetic drugs (eg angiotensin II type 1 receptor blockers, dipeptidyl peptidase IV inhibitors, neprilysin inhibitors) in patients presenting with angioedema should be elicited. Family history, especially for hereditary angioedema, should also be asked.
Physical Examination
During physical examination, look for typical lesions of urticaria. Wheals
which typically are fleeting, lasting from 30 minutes to 24 hours, have a
central swelling of variable size and shape surrounded by erythema and are associated
with itching, sometimes burning sensation. Angioedema is characterized by a
sudden, evident swelling of the lower dermis and subcutis or mucous membranes that
is sometimes painful and may last up to 72 hours. Lesions may appear on any part of the body and
disappear without scarring.
Dermographism/Dermatographism
Stroke the arm to elicit a wheal to test for
dermographism/dermatographism. Discontinue antihistamine therapy for at least
2-3 days and immunosuppressive therapy for at least a week before testing.