The Diagnostic Workup in Chronic Spontaneous Urticaria-What to Test and Why

Abstract

Background: In chronic spontaneous urticaria (CSU), the guidelines recommend very limited diagnostic procedures during the routine workup, although additional investigations might be indicated in some patients with CSU. For physicians treating patients with CSU, it is often difficult to decide which diagnostic tests are useful.

Objective: To provide recommendations on what diagnostic tests should be performed on which patients with CSU.

Methods: We performed an extensive literature search on the respective topics and identified relevant questions that should prompt diagnostic procedures based on the published evidence and expert consensus among all authors.

Results: We provide questions, diagnostic testing, where appropriate, and recommendation that should be included when assessing the history of a patient with CSU, to explore and rule out differential diagnoses, to assess patients for underlying causes and modifying conditions, to explore patients for comorbid diseases and consequences of having CSU, and to assess patients for CSU components that can help to predict their disease course and response to treatment.

Conclusions: Here, we provide physicians treating patients with CSU with information about which clues should lead to which tests and why.

Keywords: Angioedema; Autoimmunity; Autoinflammatory disease; Hives; Urticaria; Urticaria vasculitis; Wheals.