Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with chronic urticaria that is unresponsive to standard treatment, several investigations and assessments should be considered, primarily leading to specialist referral.
- If a cause for recurrent or persistent urticaria cannot be identified from the patient's history, it is appropriate to consider arranging investigations NICE CKS.
- Assessment Tools: Symptom diaries are useful to determine the frequency, duration, and severity of urticarial episodes NICE CKS. The Urticaria Activity Score (UAS7) can be used to assess the severity of urticaria NICE CKS. Additionally, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) or the Urticaria Control Test (UCT) can assess the impact of urticaria on the patient's quality of life NICE CKS.
- Drug Review: If a drug, such as a nonsteroidal anti-inflammatory drug (NSAID), is suspected to be associated with chronic urticaria, a trial period of several weeks without the medication should be considered NICE CKS.
- Food Allergy: If food allergy is suspected, particularly in children and young people, investigations may include skin prick tests and/or blood tests for specific IgE antibodies to suspected foods NICE CG116. It is important not to use serum-specific IgG testing for diagnosing food allergy NICE CG116.
- Specialist Referral: For patients whose symptoms are not well controlled on antihistamine treatment, referral to a dermatologist or immunologist is recommended NICE CKS. These specialists will then guide further investigations and management options NICE CKS.