A study of various investigative modalities in establishing the cause of chronic urticaria

INTRODUCTION: Urticaria is a transient eruption of erythematous or edematous swellings of the dermis and is usually associated with itching. Angioedema consists of transient swellings in the deeper dermal, subcutaneous, and submucosal tissues. Urticaria and angioedema occur as clinical manifestations of various immunological and inflammatory mechanisms, or they may be idiopathic. MATERIALS AND METHODS: The study included 500 patients of chronic urticaria who were recruited from the outpatient department. The detailed history, cutaneous, and systemic examination was done. All patients should be subjected to a complete blood count, absolute eosinophil count, ESR, urine analysis, stool examination, liver function test, blood sugar, and renal function test. In the patients where history will be suggestive of any specific disease, screening for hepatitis B and C, antinuclear antibody test, and rheumatoid factor. Autologous serum skin test (ASST) will be performed in all the patients with chronic urticaria. RESULTS: Out of 500 patients, 211 were female and 289 were male. Most common age group was 21–40 years (58%). Most cases (60%) of chronic urticaria were of 2–6 months duration. Most patients (47%) were worse in the evening and night time. A personal history of atopy was present in 6.6% patients. A total of 38 (7.6%) had chronic urticaria with evidence of a focus of infection. In the present study, food items were observed to be aggravating chronic urticaria in 10 (2%) patients. 19 patients of chronic urticaria were found to have concomitant systemic disease, which included 16 with thyroid disease and 3 with rheumatoid arthritis. ASST was found to be positive in 172 patients with raised serum IgE levels in 120 patients. CONCLUSION: The present study demonstrates that an extended diagnostic workup may be helpful in patients with chronic urticaria in addition to thorough history taking and physical examination for proper treatment.