Evaluation of the clinical utility of medical tests in chronic urticaria.

BACKGROUND

Medical tests are procedures used to detect, diagnose, and monitor diseases or to predict outcomes related with health. Little has been explored regarding their clinical utility in urticaria.

OBJECTIVES

This study sought to evaluate the clinical utility of medical tests commonly used in chronic urticaria, according with their operational accuracy, by assessing their impact on patient outcomes and clinical decision-making.

METHODS

The study was conducted in 3 phases. First, medical tests used in chronic urticaria were identified through a structured literature review and consultation with international urticaria specialists. Second, the operational accuracy was evaluated according with the STARD (Standards for Reporting of Diagnostic Accuracy) initiative. Third, for tests demonstrating acceptable operational performance, clinical utility was assessed based on their impact on management decisions and patient outcomes.

RESULTS

Sixteen medical tests were evaluated. For diagnostic purposes, clinical documentation through photographs and inducible challenge tests reduced misdiagnosis rates. IgE sensitization evaluation could be useful to avoid unnecessary restrictions. Acute phase reactants, serum autologous tests, IgG anti-thyroid peroxidase, and total IgE showed moderate accuracy in identifying autoimmune endotype and IgE anti-thyroid peroxidase had the highest operational performance. Several commonly ordered tests showed limited accuracy and no demonstrable clinical utility for clinical outcomes.

CONCLUSIONS

Despite significant progress in understanding the pathogenesis of urticaria, which has led to new therapeutic alternatives, the development and validation of clinically useful diagnostic tools remain limited. Many routinely requested tests provide minimal added value for clinical decision-making. Future research should prioritize the development and validation of tools that meaningfully improve medical and patient-centered outcomes.