Fast Five Quiz: Urticaria (Hives)

William James, MD


December 12, 2022

Certain aspects revealed during the physical examination suggest that urticaria could be life threatening, such as angioedema of the lips. This might suggest autoimmune thyroid disease and should prompt a joint examination for evidence of rheumatoid arthritis, connective tissue disease, or systemic lupus erythematosus. Other signs that the urticaria could possibly be life threatening include:

  • Signs of urticarial vasculitis, such as urticarial lesions that leave ecchymosis or residual hyperpigmentation upon resolution

  • Systemic signs or symptoms, particularly arthralgias, arthritis, bone pain, fever, lymphadenopathy, or weight changes

  • Signs of cholestatic liver disease or hepatitis such as hepatic enlargement, scleral icterus, or tenderness

  • Asthma or pneumonia

  • Thyromegaly

  • Evidence of infection

Raised, blanching, palpable wheals that blanch with pressure are typical with urticaria and are its key characteristic. Dermatographism — urticarial lesions caused by light scratching — are common. Previous illness is often a clue to the cause of urticaria but is not necessarily a sign of the condition being life threatening.

Learn more about the clinical presentation of urticaria.


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