Definition

Urticaria is a heterogeneous group of conditions of mixed (often unknown) origin and similar clinical manifestation. It is primarily manifested by bumps. They are an external symptom of dermal oedema due to the dilatation and increased permeability of blood vessels. The rash may be accompanied by angioedema. The name of this condition comes from urtica – a plant with stinging hairs, which cause burning lesions similar to those present in cases of urticaria.

Types

Criterion – TIME:

Acute urticaria, in which symptoms last up to 6 weeks

Chronic urticaria, lasting above 6 weeks

Criterion – ETIOLOGY:

Spontaneous urticaria

  • of known reason
  • of unknown reason

Induced urticaria

  • physical urticaria (dermographism, cold/warm-induced urticaria, delayed pressure urticaria, vibratory urticaria, solar urticaria)
  • cholinergic urticaria
  • water-induced urticaria
  • contact urticaria
Symptoms

Urticaria’s primary symptom is a bump:

  • local, painless, flat-elevated, red, pink or porcelain-white dermal oedema
  • flat, with well-defined borders
  • płaski, odgraniczony stromym brzegiem
  • of many shapes and sizes, from few millimetres up to lesions involving large areas of the skin
  • fading after pressure, it may appear anywhere on the skin
  • with burning sensation
  • appears suddenly and lasts for a short period of time (up to 24 hours), diminishing without a trace
  • with concomitant angioedema in half of patients with urticaria (usually involving lips, eyelids, cheeks, hands, feet, genitals, and even intestines and larynx). Symptoms persist up to 72 hours, and patients feel pain and distension of the skin.

In rare cases additional extracutaneous symptoms may occur:

  • headaches
  • fever
  • symptoms of asthma
  • hoarseness
  • difficulties swallowing
  • nausea
  • vomiting
  • diarrhoea
  • abdominal cramps
  • loss of appetite
  • fatigue
  • disorientation
  • hypotension
  • chest pressure
  • joints oedema
Medical interview

In urticarial diagnostics, a medical interview including the below mentioned information is essential:

  • first episode of urticaria
  • frequency of urticaria bumps appearance
  • time of bumps appearance, time of diminishing
  • time of symptomless periods
  • size, shape and location of skin lesions
  • presence of concomitant angioedema
  • presence of itchiness, pain
  • family history of urticaria and atopy
  • allergy interview (asthma, atopic dermatitis etc.)
  • presence of infectious factors, metabolic disorders, endocrine disorders or other internal disorders
  • connection of urticaria symptoms with exposure to physical conditions
  • administered drugs
  • food as a releasing factor
  • occupational interview (type of work performed)
  • social interview (lifestyle)
  • seasonality of skin lesions
  • presence of surgical, dental or orthopaedic implants (stents, cardiac stimulator, endoprostheses, dental implants)
  • associations with menstrual cycle in women
  • associations with emotional stress
  • drugs already administered and response to the therapy
Diagnostics

Examinations necessary to diagnose urticaria:

  • basic and specific laboratory tests, including serum levels of allergens-specific IgE
  • urinalysis
  • stool parasites examination
  • skin tests
        • skin prick tests and/or specific IgE levels
        • epidermal patch tests (in case of suspicion of contact urticaria)
        • intradermal allergy tests, for example autologous serum skin test/ patients’ own serum (ASST)
            Test performed as a screening for auto-reactive/ autoimmune urticaria. In some patients it causes a bump and erythema at the injection site. This reaction is caused by IgG auto-antibodies against IgE and/or FcεRI on mast cells and basophiles.

     

  • Skin biopsy (histological examination, direct immunofluorescence)
    • in case of suspicion of urticarial vasculitis
    • in patients with suspicion of mastocytosis
    • in case of general symptoms and elevated ESR
    • in case of treatment-resistant urticaria

     

  • multispecialist examinations to diagnose potential focuses of latent inflammation (laryngologial)
  • abdominal ultrasound, chest X-ray, gastroscopy, colonoscopy
  • provocation trials with physical factors panel

In our lab we have specialist equipment (dermographometer, FricTest, TempTest, cycle ergometer) necessary to diagnose induced urticaria. See more ⇨

PROVOCATION TESTS

  • DERMOGRAPHISM – induction of dermographism with wooden spatula, dermographometer, FricTest
  • COLD-INDUCED URTICARIA – thermal stimulus provocation: ice cube, limb cooling test in cold water (4 Celsius degrees), TempTest
  • WARM-INDUCED URTICARIA – thermal stimulus provocation: hot water, TempTest
  • DELAYED PRESSURE URTICARIA – compression test: with the use of dermographometer (100 g/mm2 pressure), weights
  • SOLAR URTICARIA – UVA, UVB and visible light exposure
  • WATER-INDUCED URTICARIA – wet compress
  • VIBRATORY URTICARIA – vibration device
  • EXERCISE-INDUCED URTICARIA – exercise (squats, push-ups, cycle ergometer)
  • CHOLINERGIC URTICARIA – passive warming (warm bath)

Prior to any provocation trial it is essential to discontinue antihistamine drugs for at least 5-7 days.

Examples of diagnostic tests
Examples of urticaria lesions