Table 3 First and second tools of chronic urticaria

First line

•Relevant questions:

Q1. time of onset of disease

Q2. frequency and duration of wheals

Q3. diurnal variation

Q4. shape, size, and distribution of wheals

Q5. associated angioedema

Q6. associated subjective symptoms of lesion

Q7. family and personal history regarding urticarial atopy

Q8. previous or current allergies, infections, internal diseases, or other possible causes

Q9. psychosomatic and psychiatric diseases

Q10. surgical implantations and events during surgery

Q11. gastric/intestinal problems (stool, flatulence)

Q12. induction by physical agents or exercise

Q13. use of drugs (nsaids, injections, immunizations, hormones, laxatives, suppositories, ear and eye drops, and alternative remedies)

Q14. observed correlation to food

Q15. relationship to the menstrual cycle

Q16. smoking habits

Q17. type of work

Q18. hobbies

Q19. stress (eustress and distress)

Q20. occurrence in relation to weekends, holidays, and foreign travel

Q21. quality of life related to urticaria and emotional impact

Q22. previous therapy and response to therapy

•Physical examination

•According to symptoms: Complete blood count, liver and renal function tests, C-reactive protein levels and sedimentation rate urinalysis

Second line

Vasculitis: Ig, antinuclear factor, immune complex, skin biopsy

Infections: Serologic studies for: HCV,HBV; HAV, EBV, Mycoplasma Pneumoniae. Cultures, fecal antigen of Helycobacter Pylori or Urea breath test.

Allergic: IgE, skin tests, eosinophil count, challenge, elimination diet, tryptase.

Hereditary angioedema: C3,C4, C1 esterase inhibitor.

Physical: Methacolin test, running test, ice cube test, UV and visible light exposure, dermographism, pressure test, warm water immersion test.

Autoimmune chronic urticaria: Autologous serum skin test (ASST), basophil histamine release test (BHRT).

Other: FT3,FT4, TSH, thyroid autoantibodies, celiac screening.