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The lab evaluation
for chronic urticaria
is something
that we should keep in mind
but not always perform.
We should keep it focused
based on the history
and physical exam.
For example, you might obtain
a CBC with differential
or liver function tests
if the patient
has hepatosplenomegaly
or other findings in the history
of physical suggestive
of lymphoma or other cancers.
Eosinophilia might suggest
a parasitic infection.
And in that case,
you might order
a stool study for ova
and parasites.
A TSH and Free T4
could be obtained
if the patient
has symptoms consistent
with hyper or hypothyroidism.
And if you note below, I've
also listed thyroid antibodies
likes TPO
or thyroglobulin antibodies,
which have been associated
with chronic urticaria
among other autoimmune
and immune complex diseases
that are associated with other
abnormalities and complements,
abnormalities in the ESR or ANA.
So if you're suspecting
an autoimmune
or immune complex disease,
those labs
are important to obtain.
But I wouldn't necessarily
order them on regular basis.
I would allow the history
and physical
to guide me in this.
The guidelines from the
American Academy of Allergy,
Asthma, and Immunology,
and the EAACA,
the European groups
also focuses on this
that it's important
to not obtain
these labs on a regular basis,
because usually,
the history and physical
should be able to guide you
as to whether
these are important to obtain.
The last aspect of this slide
antibody against
the Fc epsilon receptor alpha,
which has been found
in research to be associated
with chronic urticaria
in select cases.
However, it's not recommended
to obtain this lab
in routine evaluation
of the patient
with chronic urticaria,
because it doesn't help guide us
in the management
of the patient.
So usually, it's still
only obtained for research
and interest purposes.
