Urticaria self-test

Please read the question carefully in each case and then decide on an answer.

Question 1:
I have or have had itching wheals and/or swelling of the skin (angioedema).

yes

In all likelihood you have no urticaria.

Common diseases associated with changes to the skin (not wheals) and itchiness include atopic eczema or prurigo. One should also consider the possibility of a parasite infestation (fleas, bed bugs, mites). The causes of itchiness without clear visible skin changes are extraordinarily varied: diabetes mellitus, renal failure, liver diseases, hypothyroidism, allergies, tumours or blood diseases can all lead to itchiness. In most cases, however, the itchiness can be directly related to excessively dry skin. Regular application of moisturising creams and lotions, particularly following the taking of showers and baths, is often effective treatment in these cases.

Question 2:
My wheals and/or angioedema appear out of the blue, i.e. without any special trigger and without being able to predict when an attack will happen.

Yes

Question 3:
My wheals and/or angioedema have been present for more than 6 weeks.

Yes

You probably suffer from Chronic spontaneous urticaria

If your wheals and itchiness and/or swelling of the skin came “out of the blue” and have been occurring for more than 6 weeks, i.e. there is no certain and obvious trigger for your symptoms, and you cannot provoke or predict an outbreak of wheals, than in all likelihood this involves a case of chronic urticaria. More information about the clinical picture of that disease is found in the section Chronic spontaneous urticaria of this website.

If your symptoms sometimes or often, but not exclusively, occur “out of the blue”, but rather can also be provoked, then go ahead to check whether another form of urticaria might also be present in addition to chronic urticaria.

Check

You probably suffer from Acute spontaneous urticaria

If the wheals and itchiness and/or swelling of the skin have been occurring for less than 6 weeks, but “out of the blue”, then in all likelihood acute urticaria is present. More information about the clinical picture of that disease is found in the section Acute spontaneous urticaria of this website.

Question 4:
My wheals occur in locations where the skin is rubbed or scratched.

Yes

You probably suffer from urticaria factitia

If your wheals take the form of stripes and exclusively occur in places where you have scratched or rubbed yourself, then in all likelihood you are suffering from urticaria factitia, or dermographic urticaria. Specifically, it is acute dermographic urticaria if the symptoms have existed for less than 6 weeks and chronic dermographic urticaria if the symptoms have been occurring for more than 6 weeks. More information about the clinical picture of that disease is found in the section Urticaria facititia of this website.

If your symptoms sometimes or often, but not exclusively, can be provoked by rubbing or scratching, then go to question 5 to check whether another form of urticaria might also be present in addition to the dermographic urticaria.

Check

Question 5:
My wheals and/or angioedema occur in spots where my skin has come into contact with cold.

Yes

You probably suffer from cold urticaria

If the wheals and itchiness occur during contact with cold (or shortly after exposure to cold) and only on the spot exposed to the cold, then "cold urticaria" is the most likely diagnosis. Cold urticaria is a common form of physical urticaria. Further information is provided in the section Cold urticaria of this website.

If your symptoms sometimes or often occur after skin contact with cold, but also sometimes without the skin having had contact with cold, then go to question 6 to check whether another form of urticaria might also be present in addition to the cold urticaria.

Check

Question 6:
My wheals and/or angioedema occur in spots where my skin has been exposed to the sun.

Yes

You probably suffer from solar urticaria

If the wheals and itchiness are strictly restricted to patches of skin that are exposed to light, i.e. the symptoms are dependent on light irradiation (particularly solar irradiation), then solar urticaria is probably present. Solar urticaria is also generally known under the name "sun allergy." Solar urticaria is one of the less common forms of physical urticaria. Further information is provided in the section Solar urticaria of this website

If your symptoms sometimes or often, but not exclusively, occur following exposure to light, then go to question 7 to check whether another form of urticaria might also be present in addition to the solar urticaria.

Check

Question 7:
My angioedema occurs at spots where pressure is applied to the skin.

Yes

You may suffer from pressure urticaria

It's important to note that "pressure" here does not refer to rubbing or scratching (as with dermographic urticaria), but rather uniform pressure such as the kind applied to the shoulders by the straps of a backpack or to the feet when standing on a ladder. With pressure urticaria, the swelling typically occurs several hours after the exposure to pressure, is often deep below the skin and can be painful, particularly in the joint areas. The swellings are accompanied by a reddening and often only disappear completely after 1 or 2 days. The transient wheals that typically occur with other forms of urticaria are not seen here.

Antihistamines generally only help in high dosages, which is why immunosuppressive treatment may become necessary. Where possible, the quickest remedy involves removing the pressure source. For those situations where that is not possible, it's important reduce the pressure to the skin, e.g. to wear wider and softer shoes, use cushioned straps for bags and backpacks and to use similar measures to prevent the skin manifestations from occurring in the first place. The causes of pressure urticaria are unfortunately not yet investigated and characterized in detail. Pressure urticaria is one of the more uncommon forms of physical urticaria.

If your symptoms sometimes or often, but not exclusively, occur following exposure to pressure, then go to question 8 to check whether another form of urticaria might also be present in addition to the pressure urticaria.

Check

Question 8:
My wheals and/or angioedema occur in spots where my skin has been exposed to the heat.

Yes

You probably suffer from heat urticaria

If wheals and itchiness arise after contact with heat (e.g. heating pad, hot car seat in summer), then in all likelihood a heat urticaria is at play. Heat urticaria is a very uncommon form of physical urticaria. Heat urticaria involves the formation of wheals and itchiness typical of urticaria after exposure to heat, but solely at the location of the exposure. This is clearly different from cholinergic urticaria, which involves wheals after an overall increase in the body's temperature (sport, hot bath). Heat urticaria remains little researched, but it is known that it reacts well to antihistamines.

If your symptoms sometimes or often, but not exclusively, occur following localised exposure to heat, then go to question 9 to check whether another form of urticaria might also be present in addition to the heat urticaria.

Check

Question 9:
My wheals and/or angioedema occur when I get overheated.

Yes

You probably suffer from cholinergic urticaria

If you always suffer from wheals and itchiness when (overall) you get warm, be it actively through sports or agitation or passively through a bath or a spicy food (e.g. Indian or Mexican), then in all likelihood you suffer from cholinergic urticaria. With cholinergic urticaria, wheals and itchiness occur exclusively through an elevation of the body's temperature. The wheals are often initially small and distinct spots, but may flow together if the temperature continues to rise. Cholinergic urticaria is a common form of urticaria, which is often confused with exercise-induced urticaria. Further information is provided in the section Cholinergic urticaria of this website.

If your symptoms sometimes or often, but not exclusively, occur during exertion, agitation or sweating, then go to question 10 to check whether an additional form of urticaria might also be present alongside the cholinergic urticaria.

Check

Question 10:
My itchy wheals occur in places where my skin has had contact with certain substances or materials.

Yes

You probably suffer from contact urticaria

If you always get wheals and itchiness in places where your skin comes into contact with specific materials or substances, than you likely suffer from contact urticaria. The most common form of contact urticaria is the urticaria that comes after touching stinging nettles.

The histamine and acetylcholine contained in the stinging hairs of the plant are released upon contact and cause a standard burning wheal. This reaction by the skin is completely normal and harmless, and can be triggered in any human. Urticarial skin changes behave in exactly the same way following insect stings: hence contact urticaria is neither illness- nor allergy-related, but rather is a normal reaction by the skin.

The reaction is different when allergic contact urticaria is involved. Numerous natural and artificial materials can cause an allergy that then expresses itself through contact urticaria. Allergies to foods are of particular importance here. If a food allergy develops into contact urticaria, then the handling of foods leads to wheal formation on the places of contact, meaning that the hands are often affected during preparation or -- much more seriously -- the mucous membranes during eating. Food allergies expressed through contact urticaria can be very dangerous due to potential swelling in the throat area, and under some circumstances can even trigger anaphylaxis. These food allergies are often related to carrots, celery or other vegetables, apples, peanuts and hazelnuts or stone fruits. Where a contact urticaria from foodstuffs is suspected, extensive allergy testing must be performed.

Contact with animal hair can also lead to allergic wheal formation. Dog and cat hair are the prime culprits. In many cases this unfortunately dictates the removal of the animal from the household, although in some cases it may be sufficient to make changes to the way it is kept.

Latex and latex allergies can also be a cause of contact urticaria. Because no causal treatment is possible for latex allergies, all contact with latex materials must be strictly avoided–often not an easy task.

In many cases perfumes, shower gels or cosmetics are thought to be responsible for wheals and itchiness. That would only be the case if the substance leads to wheals and itchiness very soon after its application, and only at the spots where it came into contact with the skin. Wheals must not form if the substance is not applied. The same applies for detergents and fabric softeners as well as medicinal creams and ointments.

In very rare instances contact with water can lead to contact urticaria. It is not possible to be allergic to water, since humans are comprised 70% of it. Yet it is possible that the water acts as a solvent for allergens on or within the skin that cannot penetrate the skin when in a dry state.

If your wheals cannot be provoked through the triggers mentioned here, then it must be examined whether the skin manifestations here are in fact wheals, as described in the section What is urticaria on this website, or some other skin condition.

If you are certain that the skin manifestation in question involves wheals that cannot be safely and repeatedly provoked through any of the previously discussed triggers, but you nevertheless have the feeling that the episodes do not occur completely randomly, then it could involve a case of spontaneous urticaria. There are various triggers that can cause an episode, but do not always do so reliably. This generally involves drugs (principally pain medicine) or foods (including those that are generally described as "healthy"). More information on the clinical picture of that disease is found in the section Spontaneous acute urticaria if the symptoms have existed for less than 6 weeks, and in the section Spontaneous chronic urticaria if the symptoms have existed for more than 6 weeks.

Emotional strains, stress and heat are non-specific triggers of urticaria; those factors can lower the threshold for an approaching urticaria episode, leading to quicker or more pronounced wheal formation. Stress and emotional strain can also lead to an altered self-perception, meaning that wheals and itchiness seem even more threatening than they really are – which leads to more stress, and so on.

Wheals that do not itch or that only itch a little or that remain in the same place for more than 24 hours, or long lasting wheals that react only to cortisone preparations, must be discussed on an individual basis with a dermatologist. In those cases a skin sample must be taken. The actual duration of a wheal should be checked ahead of time through colour marking.