Diagnosis of Hives: Clinical History, Skin Tests, and Acute vs Chronic Urticaria

Hives is a common dermatological condition characterized by the appearance of welts and itching. Its diagnosis can be challenging due to the variety of underlying causes and diverse clinical presentations. The distinction between acute vs chronic urticaria is crucial, as it influences the diagnostic and therapeutic approach. Acute urticaria is defined by episodes lasting less than six weeks, while chronic urticaria persists beyond this period.

The diagnosis of hives begins with a detailed clinical history and a thorough physical examination. The clinical history should include questions about the duration, frequency, and characteristics of the welts, as well as possible triggers such as foods, medications, or environmental factors. In the case of chronic inducible urticaria, it is essential to identify specific stimuli that provoke symptoms, such as cold, heat, or exercise.

Skin tests are a valuable tool in the diagnosis of hives, especially when an underlying allergy is suspected. These tests may include skin prick tests to identify sensitivities to specific allergens. In cases of suspected drug hypersensitivity, controlled provocation tests may be necessary to confirm the diagnosis. Additionally, the use of biomarkers is emerging as a promising tool to personalize the diagnosis and treatment of allergic diseases, including hives.

In conclusion, the diagnosis of hives requires a meticulous approach that combines a detailed clinical history with specific diagnostic tests. Accurate identification of triggers and differentiation between acute and chronic urticaria are fundamental steps to guide appropriate treatment. The integration of new technologies and biomarkers may further enhance diagnostic accuracy and treatment efficacy.

Referencias

• [1] Chronic inducible urticaria: classification and prominent features of physical and non-physical types
• [2] The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease
• [3] Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma

Created 6/1/2025