Evaluation of urticaria
Summary
Urticaria, also known as welts, hives, or wheals, is characterized by the appearance of intensely pruritic erythematous plaques.[1] It appears clinically as pruritic, pale, blanching swellings of the superficial dermis that last for up to 24 hours. Lesions may be small, large, giant, oval, or annular.[Figure caption and citation for the preceding image starts]: Acute urticaria: typical whealsFrom the collection of Adam Reich, MD, PhD [Citation ends].
[Figure caption and citation for the preceding image starts]: Typical lesions seen in acute or chronic urticariaFrom the collection of Stephen Dreskin, MD, PhD [Citation ends].
[Figure caption and citation for the preceding image starts]: Urticaria: whealsFrom the collection of Adam Reich, MD, PhD [Citation ends].
Urticaria affects 10% to 25% of the population and can occur in any age group.[2] It is a mast-cell-driven disease. The triggering mechanisms for mast-cell activation in urticaria are not well defined but seem to be multiple and diverse.[3]
Urticaria is classified according to duration of symptoms:
Acute urticaria: the occurrence of spontaneous wheals, angioedema, or both for <6 weeks[1][2][3]
Chronic urticaria: urticaria that has been continuously or intermittently present for ≥6 weeks.[1][3][4]
Chronic urticaria is classified into 2 subtypes:[3]
Chronic spontaneous urticaria: spontaneous appearance of wheals, angioedema, or both ≥6 weeks due to known or unknown causes.
Inducible urticaria, for example delayed pressure urticaria, heat urticaria, solar urticaria, symptomatic dermatographism, vibratory angioedema, aquagenic urticaria, cholinergic urticaria, and contact urticaria.
Urticaria complicated by angioedema
Some people have urticaria that is complicated by angioedema, a swelling of the deeper dermis and tissues (e.g., mucosal surfaces), with laryngeal edema potentially causing respiratory distress and death.[3] Angioedema is commonly associated with urticaria and may occur at any age.[5] It may not necessarily be seen at the first urticarial episode, but risk of angioedema increases with greater exposure to the allergenic substance.[6]
Clinical presentation of angioedema may include nonpitting edema of the subcutaneous tissues involving lips, face, neck and extremities and/or submucosal tissues affecting the oral cavity, larynx and gastrointestinal system.[7] Associated symptoms may also be present. These are dependent on the underlying etiology. Examples include flushing, bronchospasm, abdominal pain, diarrhea and vomiting.[7] Angioedema without urticaria should prompt further evaluation.[1][Figure caption and citation for the preceding image starts]: Angio-oedema of the lips in a patient who also has urticariaFrom the collection of Stephen Dreskin, MD, PhD [Citation ends].
Differentials
Common
- Acute spontaneous urticaria
- Chronic spontaneous urticaria
- Chronic inducible (physical) urticaria
- Drug eruptions
- Insect bite
- Viral exanthem
- Atopic dermatitis
- Allergic contact dermatitis
- Irritant contact dermatitis
Uncommon
- Erythema multiforme
- Stevens-Johnson syndrome
- Auriculotemporal syndrome
- Bullous pemphigoid
- Cutaneous mastocytosis
- Systemic mastocytosis
- Mast cell activation syndrome
- Urticarial vasculitis
- Transfusion reactions
- Serum sickness
- Cold-induced urticaria, Muckle-Wells syndrome, neonatal multisystem inflammatory disease
- Anaphylaxis
Contributors
Authors
Marilyn Li, MD
Associate Professor of Clinical Pediatrics, Clinician Educator
Director, Quality Improvement and Educational Activities For The Breathmobile Program
Keck School of Medicine, USC
Los Angeles
CA
Disclosures
ML is an unpaid board member of the California Society of Allergy Asthma and Immunology (CSAAI). ML has created CME content on asthma, anaphylaxis, and immunotherapy.
Kenny Y.C. Kwong, MD
Clinical Associate Professor of Pediatrics
Division of Allergy-Immunology
Los Angeles General Medical Center
Los Angeles
CA
Раскрытие информации
KYCK is a consultant and independent contractor for Thermo-Fisher Scientific Immunodiagnostics Division (Phadia).
Выражение благодарностей
Dr Marilyn Li and Dr Kenny Y.C. Kwong would like to gratefully acknowledge Dr Nanette Silverberg, and Dr Mary Lee-Wong, previous contributors to this topic.
Раскрытие информации
NS and MLW declare that they have no competing interests.
Рецензенты
Christopher Parrish, MD
Assistant Professor
Pediatrics and Internal Medicine
Division of Allergy and Immunology
UT Southwestern
TX
Раскрытие информации
CP declares that he has no competing interests.
Amor Kachamoune, MD
Assistant Professor
New York University School of Medicine
New York
NY
Раскрытие информации
AK declares that he has no competing interests.
Bettina Wedi, MD
Professor
Head of Allergy Division
Department of Dermatology and Allergy
Hannover Medical School
Hannover
Germany
Раскрытие информации
BW declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. Аннотация
European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication].Полный текст
Sabroe RA, Lawlor F, Grattan CEH, et al. British Association of Dermatologists guidelines for the management of people with chronic urticaria 2021. Br J Dermatol. 2022 Mar;186(3):398-413.Полный текст Аннотация
Moellman JJ, Bernstein JA, Lindsell C, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014 Apr;21(4):469-84.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Лифлеты для пациента
Dermatitis (seborrheic) of the body
Больше Лифлеты для пациента
Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice
Использование этого контента попадает под действие нашего заявления об отказе от ответственности