Choosing Wisely:

Don’t routinely do diagnostic testing in patients with chronic urticaria.

Rationale and Comments: In the overwhelming majority of patients with chronic urticaria, a definite etiology is not identified. Limited laboratory testing may be warranted to exclude underlying causes. Targeted laboratory testing based on clinical suspicion is appropriate. Routine extensive testing is neither cost-effective nor associated with improved clinical outcomes. Skin or serum-specific IgE testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as a provoking or perpetuating factor for urticaria.
Sponsoring Organizations:
  • American Academy of Allergy, Asthma and Immunology
  • Sources:
  • American Academy of Allergy, Asthma and Immunology guidelines
  • Disciplines:
  • Allergy and immunologic
  • References: • Wanderer AA, et al. The diagnosis and management of urticaria: a practice parameter. Ann Allergy Asthma Immunol. 2000;85:521-44.
    • Tarbox JA, et al. Utility of routine laboratory testing in management of chronic urticaria/angioedema. Ann Allergy Asthma Immunol. 2011;107:239-43.
    • Bernstein IL, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 suppl 3):S1-148.
    • Kozel MM, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol. 2003;48(3):409-16.

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