Diagnosis

1. Anamnesis

Basic four

- Present Illness
Clinical presentation of urticaria such as red, raised, itchy rash with batches of red or
white welts, which are known as wheals and/or accompany by angioderma1
- Past History
There is history of similar symptom or disease. History of having systemic diseases such
as autoimmune, connective tissue and lymphoproliferative disorders may possible cause
to urticaria especially chronic urticaria2,3
- Family History
Personal and family of atopy more likely to be allergy-induced urticaria4
- Social History
Occupational exposure to chemical or inhalant, to determine potential long term trigger5

Sacred seven

- Onset
Onset of urticaria is needed to find the etiology
- Site
Location of wheals that is associated with itch and its distribution in body
- Quantity
Frequency and duration for wheal and how severe the symptom occur also certain
condition that associated with events to become more frequent
- Quality
Quality of life related to urticaria and emotional impact, sometimes wheals that
associated with itch, often worse at night. The pruritus can be debilitating enough to
affect activities of daily living and quality of live2
- Chronology
Sometimes patients seek a physician because of food, drug (antibiotic or NSAID), insect
sting or transfusion as trigger of urticaria6
- Modification factor
Infection, increase activity, chill, hot air, dust might be factor that aggravate urticaria
- Associated symptom
Pruritus, angioderma, dizziness, breathing difficulties etc

2. Physical Assesment

Urticaria presents as pink or white well- circumscribed, raised weals surrounded

by an erythematous base and central pallor. These weals may become confluent, forming
large plaques. Urticarial lesions may vary in size and shape, ranging from annular to
serpinginous outlines, and ranging from lesions that are millimetres to a few centimetres
 in size. Morphology of these weals may help distinguish between physical urticarias and
other subgroups of urticaria. Weals may be accompanied by angioedema, which is non-
pitting asymmetric swelling that may affect the lips, cheeks, limbs, genitals and
periorbital area.2 Physical examination should also be directed at detecting possible
causes if none is apparent on history, with review of lymph nodes, eyes, joints, throat,
neck, ears, lungs, heart, and abdomen (looking for signs of possible connective tissue
disorders, thyroid disease, lymphoreticular neoplasms).3 Physical examination include
identifying and characterizing any current lesions, testing for dermatographism (urticaria,
often linear, that forms with stroking or rubbing of unblemished skin), and checking for
signs of systemic illness. 7

1. WAO Guideline

2. Perera, E., & Sinclair, R. (2014). Evaluation , diagnosis and management of chronic
urticaria, 43(9), 621–625.)

3. Sinclair, D. J. (2014). Urticaria. Starship Health Clinical Guideline, (June), 1–3.

Retrieved from http://www.adhb.govt.nz/starshipclinicalguidelines/Urticaria.htm

4. Zuberbier, T., Aberer, W., Asero, R., Bindslev-Jensen, C., Brzoza, Z., Canonica, G. W., …
Maurer, M. (2014). The EAACI/GA 2 LEN/EDF/WAO Guideline for the definition,
classification, diagnosis, and management of urticaria: the 2013 revision and update.
Allergy, 69(7), 868–887. http://doi.org/10.1111/all.12313

5. The diagnosis and treatment of. (n.d.), 6–13. http://doi.org/10.1016/S0268-

960X(02)00044-9

6. Godse KV, Zawar V, Krupashankar D, et al. CONSENSUS STATEMENT ON THE

MANAGEMENT OF URTICARIA. Indian Journal of Dermatology. 2011;56(5):485-
489. doi:10.4103/0019-5154.87119.

7. Schaefer, P. (2011). Urticaria: Evaluation and Treatment. American Family Physician,

83(9), 1078–1084.