What is the diagnosis for urticaria (hives) and angioedema (rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues)?

From the Guidelines

Urticaria (hives) and angioedema are diagnosed based on a thorough history, physical examination, and diagnostic workup, including the 7 Cs: confirmation, causes, cofactors, comorbidities, consequences, components, and course, as outlined in the most recent guidelines 1. The diagnosis of urticaria and angioedema involves a comprehensive evaluation of the patient's symptoms, medical history, and physical examination findings.

• Key considerations include:
  • The duration and characteristics of the symptoms, such as the presence of wheals, angioedema, or both
  • The presence of any underlying conditions or triggers, such as autoimmune disorders, allergies, or physical stimuli
  • The impact of the symptoms on the patient's quality of life and daily activities
  • The results of any diagnostic tests, such as blood work or skin biopsies The diagnostic workup for urticaria and angioedema may involve a range of tests and assessments, including:
• A thorough medical history and physical examination
• Laboratory tests, such as complete blood counts, erythrocyte sedimentation rates, and IgE levels
• Skin biopsies or other diagnostic procedures to rule out underlying conditions such as urticarial vasculitis
• Provocation testing to identify specific triggers or causes of the symptoms The most recent guidelines recommend a step-wise approach to diagnosis, starting with a thorough history and physical examination, followed by basic tests and specialized diagnostic procedures as needed 1. In some cases, the diagnosis of urticaria or angioedema may be straightforward, while in other cases, it may require a more comprehensive evaluation and diagnostic workup.
• It is essential to consider the patient's individual symptoms, medical history, and test results when making a diagnosis and developing a treatment plan. The treatment of urticaria and angioedema typically involves a combination of medications, lifestyle modifications, and avoidance of triggers.
• Medications may include antihistamines, corticosteroids, and other agents to relieve symptoms and reduce inflammation.
• Lifestyle modifications may include avoiding known triggers, managing stress, and maintaining a healthy diet and exercise routine. The goal of treatment is to alleviate symptoms, improve quality of life, and prevent complications, as outlined in the most recent guidelines 1.

From the FDA Drug Label

Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. The signs and symptoms associated with anaphylaxis include flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with hypotension, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria or angioedema, swelling of the eyelids, lips, and tongue. The diagnosis for urticaria (hives) and angioedema (rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues) is an allergic reaction (Type I), which may be a symptom of anaphylaxis 2.

• Key symptoms include:
  • Urticaria
  • Angioedema
  • Other symptoms such as flushing, pruritus, and swelling of the eyelids, lips, and tongue.

From the Research

Diagnosis of Urticaria and Angioedema

The diagnosis of urticaria and angioedema is based on clinical examination and history, with the goal of identifying underlying causes and ruling out differential diagnoses 3, 4, 5, 6, 7.

• Urticaria is clinically defined as the occurrence of transient papular skin and/or mucosal lesions or subcutaneous lesions called angioedema 5.
• Angioedema can occur in the absence of urticaria and can be broadly divided into histamine-mediated and non-histamine-mediated angioedema 4.
• A limited nonspecific laboratory workup should be considered unless elements of the history or physical examination suggest specific underlying conditions 7.

Classification of Urticaria

Urticaria can be classified as:

• Acute or chronic, with chronic urticaria defined as a clinical course over more than 6 weeks 5, 6.
• Spontaneous or inducible, in the case of chronic urticaria 6.
• Urticaria can also be classified as physical, with different clinical forms of urticaria able to coexist in the same patient 3.

Diagnostic Approach

The diagnostic approach to urticaria and angioedema involves:

• Clinical examination and history to identify underlying causes and rule out differential diagnoses 3, 4, 5, 6, 7.
• Questioning and a careful clinical examination to rule out differential diagnoses 5.
• Limited nonspecific laboratory workup unless elements of the history or physical examination suggest specific underlying conditions 7.