Approach to the Patient with Urticaria/Angioedema

Approach to the Patient with Urticaria/Angioedema - Flowchart Approach to the Patient with Urticaria/Angioedema Approach to the Patient with Urticaria/Angioedema

«Flowchart»

Clinical appearance: wheals, angioedema

History: recurrent transient hives or swelling

Duration of individual hive

History

physical stimulus
physical challenge

History

physical stimulus
physical challenge

History

physical stimulus
physical challenge

30 min to 2 h

4 h–36 h

24–48 h with either bruising, severe arthralgia, fever, ↓ C4

24–48 h with either bruising

Physical
urticaria

Physical

End

Consider drugs, foods, food skin testing, infection (particularly in children), other identifiable stimulus

Course <6 wk

Course >6 wk

Acute
urticaria/angioedema

Acute

Chronic
idiopathic urticaria

Chronic

Chronic
autoimmune urticaria

Chronic

Thyroid function tests, anti-microsomal antibody, anti-thyroglobulin antibody, autologous skin test, in vitro-anti-IgE receptor

Positive

Positive Positive

Negative

Negative Negative

Urticarial vasculitis

Skin biopsy

Negative

Negative Negative

Positive

Positive Positive

Wheals ± angioedema