From the Guidelines
For a pediatric patient presenting with hives and swelling of the hands and mouth, I would recommend a focused panel of blood tests to evaluate for allergic reactions and potential anaphylaxis, including complete blood count with differential, specific IgE antibody testing, tryptase levels, C-reactive protein, ESR, and basic metabolic panel. These tests can help establish the diagnosis, identify potential triggers, and guide management decisions. The most recent and highest quality study, 1, provides guidance on the diagnosis and management of anaphylaxis, emphasizing the importance of prompt recognition and treatment. Key tests to consider include:
- Complete blood count with differential to check for elevated eosinophils
- Specific IgE antibody testing to identify potential allergen triggers
- Tryptase levels, if drawn within 3 hours of symptom onset, to confirm mast cell degranulation and anaphylaxis
- C-reactive protein and ESR to differentiate allergic from infectious causes
- Basic metabolic panel to assess overall physiologic status However, treatment should never be delayed for test results if the patient shows signs of anaphylaxis, as immediate administration of epinephrine, antihistamines, and corticosteroids may be life-saving, as recommended by 1. Additionally, the study 1 highlights the importance of considering food allergies in pediatric patients with symptoms such as hives and swelling, and the study 1 provides guidance on the use of skin prick testing and serum specific IgE level determination to assess for immediate/type I hypersensitivity reactions. But the most recent study 1 takes precedence in guiding management decisions.
From the Research
Laboratory Evaluation for Pediatric Patient with Hives and Swollen Hands and Mouth
- The approach to a pediatric patient with hives and swollen hands and mouth may involve laboratory evaluation to confirm the etiology of acute urticaria 2
- Laboratory tests may be necessary to identify the cause of urticaria, especially if the symptoms are severe or persistent 2
- However, universal allergy testing for food allergens or aeroallergens is not recommended for chronic urticaria, as it may lead to false-positive results and unnecessary avoidance of allergens or foods 2
- In cases where urticarial vasculitis is suspected, skin biopsy may be considered, especially if the lesions are painful, present for more than 48 hours, leave scars/hyperpigmentation, or are accompanied by systemic symptoms such as fever, weight loss, and arthritis 2
Relevant Blood Work
- There is no specific blood work mentioned in the provided studies that is directly relevant to the diagnosis of hives and swollen hands and mouth in pediatric patients
- However, the study on approach to children with hives suggests that laboratory evaluation may be needed to confirm the etiology of acute urticaria, but does not specify particular blood tests 2
- The other studies provided do not appear to be relevant to the diagnosis or management of hives and swollen hands and mouth in pediatric patients 3, 4