ICUS HVC

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Should HCV Testing Become Standard Procedure for Urticaria?

by Jeffrey D. Bernhard, MD
University of Massachusetts Medical Center

Reference
Kanazawa K et al. Hepatitis C virus infection in patients with urticaria. J Am Acad Dermatol 1996; 35:195-198.

SUMMARY
Fifty-eight patients with urticaria for more than 6 weeks and 21 patients with urticaria for less than 6 weeks were tested for markers of hepatitis C virus (HCV) infection. For comparison, 1692 apparently healthy blood donors were also tested. Of the 79 patients, anti-HCV antibody was detected in 19 (24%) and HCV RNA was detected in 17 (22%). Each of the latter also tested positive for anti-HCV antibody; only 18 of the 1692 control subjects tested positive for anti-HCV. The authors conclude that "HCV could be a significant cause of urticaria."

COMMENT
What tests, if any, should be done to evaluate patients with urticaria? Few questions of daily practice are more acute or as chronically controversial. Testing for HCV infection may be worth considering.

Since hepatic enzymes (ALT and AST) were elevated in many--but not all--of the patients in whom HCV RNA was detected, liver function tests may not be a sufficient screen for HCV infection in this setting.

Whether the prevalence of HCV in urticaria in other geographic areas is similar remains to be seen.

HBV is a known cause of urticaria; it would not be surprising if HCV turns out to be an important cause as well.

HCV has now been associated with several cutaneous diseases: porphyria cutanea tarda, lichen planus, cutaneous vasculitis, polyarteritis nodosa, erythema nodosum, erythema multiforme, prurigo, and mixed cryoglobulinemia.

It is premature to recommend that every patient with acute or chronic urticaria of undetermined origin be tested for HCV, but it is not premature to consider such a test, and to go ahead and perform it if features of the presentation or epidemiology raise the level of suspicion.