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Guidance on the diagnostic workup in chronic spontaneous urticaria

Published online: June 2021

For patients with chronic spontaneous urticaria (CSU), limited testing is recommended in routine diagnostics, but an expanded diagnostic program should be performed based on the patient's history. However, it is often difficult for treating physicians to decide which additional diagnostic tests are useful.

In their study published in The Journal of Allergy and Clinical Immunology: In Practice, Metz et al. have identified relevant questions for daily clinical practice that should prompt specific diagnostic procedures in CSU patients. The recommendations for these questions are based on a thorough review of the published evidence and an expert consensus among all of the authors.

The authors formulate simple questions that should be asked by the treating physician at the initial consultation of CSU patients. These questions follow the “7Cs” in CSU: Confirm (ruling out differential diagnoses), Cause (looking for indicators of different types of autoimmune CSU), Cofactors (identifying triggers/aggravators), Comorbidities, Consequences (e.g., identifying sleep problems, distress etc.), Components (i.e., assessing potential biomarkers), and Course (monitoring CSU activity, impact and control). Asking the appropriate questions will prevent unnecessary and potentially expensive testing and increase diagnostic accuracy and treatment effectiveness. Thus, this structured approach not only leads to improved patient management, but also to higher patient and physician satisfaction.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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