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When Your Patients Are Itching to See You: Not All Hives Are Urticaria

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When patients present with itching and the perception that they have hives, what other processes can mimic urticaria? With the exception of urticarial vasculitis, urticaria typically lasts less than 24 to 36 hours at one site. A rash that persists longer should raise the suspicion of another inflammatory process. When the hive-like rash does not respond to antihistamines, a biopsy may reveal an alternative diagnosis. All biopsies should also be submitted for immunofluorescence to exclude atypical presentations of inflammatory bullous disease presenting with urticaria. However, even biopsies can be subject to misinterpretation and if the clinical picture does not support the biopsy, an alternative consultation with a dermatopathologist may be required. The extent of the laboratory and radiologic evaluation should be dictated by the clinician's suspicion of alternative causes for the hive(s) because rarely malignancies may present with urticaria. Common things are indeed common with urticaria and the more urticaria does not appear to be typical, the more often the clinician should consider alternative diagnoses. (Allergy and Asthma Proc 26:1–7, 2005)
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Document Type: Research Article

Publication date: January 1, 2005

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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