Chronic urticaria (CU) (>6 weeks) is classified in two subtypes: chronic spontaneous urticaria and chronic inducible urticaria. In ≤90% of the chronic spontaneous urticaria cases, the search for underlying causes is not successful in routine clinical practice. Patients with CU are a challenge for physicians. A thorough medical history and physical examination to identify all possible eliciting factors and causes are important for the diagnosis. Existing international guidelines are usually generalised and not very useful for clinical practice and an oriented medical history in the first doctor–patient meeting.
The aim of this study was to provide a checklist and a collection of items that should be included in a correct medical history, allowing physicians to quickly and easily identify the mean characteristics of the disease and the possible eliciting factors, to enable an accurate diagnosis and management of the disease.
First, we conducted a literature search for relevant studies of CU until December 2016 using MEDLINE, the Cochrane Library for systematic reviews of databases, and the PubMed search engine. A total of 82 articles were found and all items to be incorporated into the first checklist were discussed.
A checklist was developed and a collection of items essential for anamnesis and diagnosis of CU and typical symptoms or characteristics according to CU subtypes was compiled. The items of the checklist included time of onset of disease, duration of wheals, onset of lesions after the trigger, symptoms onset, shape, size, colour, and distribution of wheals, associated angioedema, associated subjective symptoms of lesions, stimuli (such as physical, food, drugs, infection), diurnal and nocturnal variation, evaluation of the activity with UAS7 and the urticaria control test, and laboratory results, including complete blood count and others.
Being confronted with a patient with urticaria can be frustrating for both patient and physician. As lesions may persist, eliciting factors are confusing, and this could lead to a misdiagnosis of the disease. This checklist and collection of items can help focus, orientate, and save time in a medical consultation, aiding physicians to diagnose and manage CU more accurately.
Further research is recommended to validate this tool, which needs to be adapted to the context and reality of each country, depending on the most frequent aetiology of CU. Furthermore, this checklist could be useful as a means of consultation using, for example, a smartphone.