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

Clinical appearance: wheals, angioedema

Clinical appearance: wheals, angioedema

History: recurrent transient hives or swelling

History: recurrent transient hives or swelling

History: recurrent transient hives or swelling

Duration of individual hive

Duration of individual hive

Duration of individual hive

History


physical stimulus
physical challenge

History


physical stimulus
physical challenge

History


physical stimulus
physical challenge


physical stimulus
physical challenge

30 min to 2 h

30 min to 2 h

30 min to 2 h

4 h–36 h

4 h–36 h

4 h–36 h

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

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

24–48 h with either bruising

Physical
urticaria

Physical
urticaria

Physical
urticaria

Physical

End

End

End

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

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

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

Course <6 wk

Course <6 wk

Course <6 wk

Course >6 wk

Course >6 wk

Course >6 wk

Acute
urticaria/angioedema

Acute
urticaria/angioedema

Acute
urticaria/angioedema

Acute

Chronic
idiopathic urticaria

Chronic
idiopathic urticaria

Chronic
idiopathic urticaria

Chronic

Chronic
autoimmune urticaria

Chronic
autoimmune urticaria

Chronic
autoimmune urticaria

Chronic

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

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

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

Positive

Positive

Positive Positive

Negative

Negative

Negative Negative

Urticarial vasculitis

Urticarial vasculitis

Urticarial vasculitis

Urticarial vasculitis

Skin biopsy

Skin biopsy

Skin biopsy

Negative

Negative

Negative Negative

Positive

Positive

Positive Positive

Wheals ± angioedema

Wheals ± angioedema

Wheals ± angioedema

Clinical appearance: wheals, angioedema

History: recurrent transient hives or swelling

Wheals ± angioedema

Duration of individual hive

30 min to 2 h

30 min to 2 h

30 min to 2 h

4 h–36 h

4 h–36 h

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

24–48 h with either bruising

1==>5

5==>13

13==>6

6==>7