Chronische Urtikaria – rationelle Diagnostik

Abstract

After the implementation of DRGs, it seemed necessary to review the standardized diagnostic procedures with respect to effectiveness in identifying causes for chronic urticaria in order to reduce contents in a medically and economically meaningful manner. The test findings of 567 patients with chronic urticaria or angioedema hospitalized from 1989 - 2000 in the Department of Dermatology in Niimberg were analyzed retrospectively. The diagnostic procedures consisted of anamnesis, search for focal infections, allergy tests and provocation tests of intolerance reactions. The main emphasis of the study was placed on the intolerance test to ASA. By potato-rice diet - carried out as prerequisite for provocation tests - symptoms ceased in 37.1% of patients and an improvement of symptoms was shown in 10.1%. During intolerance tests, 27.0% of the provoked patients reacted to ASA. The remaining intolerance substances indometacin, paracetamol, food additives and natural salicylates rarely produced an intolerance reaction. Also, administering additive and natural salicylates enriched food provoked only a few intolerance reactions. Rational diagnostic procedures of the chronic urticaria consist of several steps. During the provocation test the potato-rice diet should be carried on because many patients expressed a total elimination of signs after a short time. The provocation test with ASA should be retained because of numerous positive reactions. However, the provocation test with food additives and salicylates and the provocation food do not represent a compelling component in routine diagnostics of chronic urticaria any longer. By uncovering intolerance reaction the causative factors of urticaria is found in a few cases. Therefore, the search for focal infections and autoimmune disorders should always be conducted because chronic urticaria can represent a multifactorial occurrence.