Differential diagnosis of chronic urticaria

Brodell, Lindsey A.; Beck, Lisa A.

doi:10.1016/s1081-1206(10)60438-3

Cited by 29 publications

(21 citation statements)

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“…Therefore, the diagnostic approach in children and adults is the same [26, 54, 55]. However, it should be noted that infants are more prone to develop acute urticaria secondary to an infection.…”

Section: Resultsmentioning

confidence: 99%

“…What is the differential diagnosis to be established for a patient with CSU?. Apart from urticaria vasculitis for which diagnosis is made through biopsy, It can be difficult to differentiate hives from other dermatoses [26] ( Table 4). However, the natural course differs in these pathologies.…”

Section: Diagnosis Of Csu Physical Examination and Complementary Tesmentioning

confidence: 99%

“…Chronic spontaneous urticaria is less frequent in children, but in general, it shares the underlying causes and physiopathology of CSU in adults. Therefore, the diagnostic approach in children and adults is the same [26,54,55]. However, it should be noted that infants are more prone to develop acute urticaria secondary to an infection.…”

Section: Diagnosis Of Csu Physical Examination and Complementary Tesmentioning

confidence: 99%

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Management of urticaria: not too complicated, not too simple

Ferrer

Bartra

Giménez‐Arnau

et al. 2015

Clin Experimental Allergy

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In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnosis Of Csu Physical Examination and Complementary Tesmentioning

confidence: 99%

Section: Diagnosis Of Csu Physical Examination and Complementary Tesmentioning

confidence: 99%

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Management of urticaria: not too complicated, not too simple

Ferrer

Bartra

Giménez‐Arnau

et al. 2015

Clin Experimental Allergy

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“…While the disease is usually self-restricting, it can become a life-threatening condition due to asphyxia in the case of anaphylaxis and laryngeal edema (4)(5)(6). Recurrent attacks may disturb the patient's physical appearance, cause anxiety and effect the quality of life (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…The variety of comorbidities and allergens have drawn the attention of researchers and numerous studies have been carried out on the subject. As CU constitutes a heterogenous disease group, all examinations for the determination of the etiology should be completed before concluding that the disease is idiopathic (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Clinical Features of Patients with Chronic Urticaria and the Results of the Skin Prick Tests

Bilgir¹,

Özdemir²,

Değirmenci³

et al. 2019

Asthma Allergy Immunol

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Objective: Chronic urticaria (CU), which is mostly idiopathic, may also be a sign of an allergic or systemic disease. A variety of diseases and allergens that accompany CU have been reported in various studies. The aim of this study was to investigate the factors that play a role in the etiology of CU. Materials and Methods: The demographic and clinical data from 302 patients-aged over 18 years-who were being monitored for CU were recorded. Several tests were performed to analyze comorbidities such as infection, malignancy, and autoimmune and rheumatic diseases. Skin Prick Test (SPT) results and questionnaires were reviewed. Results: Two hundred and thirteen out of the 302 patients with a mean age of 40.26±14.3 years were females. The duration of CU was 43.30±62.60 months and 42.9% of the patients had comorbidities. The most common disease was autoimmune thyroiditis (13.9%). Fifty-five percent of the patients were sensitive to inhalant allergens, and 5% exhibited allergen positivity for food. The most common allergens were house (43.7%) dust mites. Allergen positivity was 37.2% in those with comorbidities, while it was 62.8% in those without any comorbidities and this relationship was statistically significant (p<0.05). Conclusion: This study showed that there was an association between house dust mite and CU dust sensitivity. House dust mite sensitivity may trigger CU.

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A novel histopathological scoring system to distinguish urticarial vasculitis from chronic spontaneous urticaria

Puhl

Bonnekoh

Hawro

et al. 2021

Clinical & Translational All

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Background: Urticarial vasculitis (UV) is defined by long-lasting urticarial lesions combined with the histopathologic findings of leukocytoclastic vasculitis. As one of the major unmet needs in UV, diagnostic criteria are rather vague and not standardized. Moreover, there seems to be considerable overlap with chronic spontaneous urticaria (CSU), particularly for the normocomplementemic variant of UV.Therefore, this study aimed to develop a diagnostic scoring system that improves the histopathologic discrimination between UV and CSU.Methods: Lesional skin sections of patients with clinical and histopathologic diagnosis of UV (n = 46) and CSU (n = 51) were analyzed (blinded to the diagnosis) for the following pre-defined criteria: presence of leukocytoclasia, erythrocyte extravasation, fibrin deposits, endothelial cell swelling, ectatic vessels, blurred vessel borders, dermal edema, intravascular neutrophil, and eosinophil numbers and numbers of dermal neutrophils, macrophages and mast cells.Results: The greatest differences between UV and CSU samples were observed for leukocytoclasia (present in 76% of UV vs. 3.9% of CSU samples; p < 0.0001), erythrocyte extravasation (present in 41.3% of UV vs. 2.0% of CSU samples; p < 0.0001), and fibrin deposits (present in 27.9% of UV vessels vs. 9.7% of CSU vessels; p < 0.0001). Based on these findings, we developed a diagnostic score, the urticarial vasculitis score (UVS), which correctly assigned 37 of 46 cases of UV and 49 of 51 cases of CSU to the previously established diagnosis. Conclusion:Our results suggest that the UVS, a combined quantitative assessment of the three criteria leukocytoclasia, fibrin deposits and extravasated erythrocytes, distinguishes UV from CSU in skin histopathology. The UVS, if validated in larger patient samples, may help to improve the diagnostic approach to UV.

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Differential diagnosis of chronic urticaria

Cited by 29 publications

References 50 publications

Management of urticaria: not too complicated, not too simple

Management of urticaria: not too complicated, not too simple

Clinical Features of Patients with Chronic Urticaria and the Results of the Skin Prick Tests

A novel histopathological scoring system to distinguish urticarial vasculitis from chronic spontaneous urticaria

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