Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Urticaria


Related Terms

  • Hives

Differential Diagnosis

Specialists

  • Allergist/Immunologist
  • Dermatologist
  • Immunologist
  • Internal Medicine Physician

Comorbid Conditions

  • Allergies
  • Bites
  • Bullous pemphigoid
  • Chronic pruritus nonurticarial
  • Connective tissue diseases
  • Dermatitis herpetiformis
  • Hypersensitivity vasculitis and / or urticarial vasculitis
  • Infection
  • Leukemia
  • Lymphoma
  • Polymyositis
  • Pruritic urticarial papules and plaques of pregnancy (PUPPP), polymorphic eruption of pregnancy (PEP)
  • Rheumatoid arthritis
  • Stings
  • Systemic lupus erythematosus
  • Systemic mastocytosis
  • Urticaria pigmentosa or other mast cell releasability syndromes
  • Various carcinomas
  • Vasculitis

Factors Influencing Duration

The length of disability may be influenced by the ability to identify and eliminate the causative agent, the effectiveness of the symptomatic treatment, plus the location, extent, and severity of reaction. Antihistamine medication may cause sedation.

Medical Codes

ICD-9-CM:
708.0 - Allergic Urticaria
708.1 - Idiopathic Urticaria
708.2 - Urticaria due to Cold and Heat; Thermal Urticaria
708.3 - Dermatographic Urticaria; Dermatographia; Factitial Urticaria
708.4 - Vibratory Urticaria
708.8 - Other Specified Urticaria; Nettle Rash; Chronic; Recurrent Periodic
708.9 - Urticaria, Unspecified

Overview

Urticaria, commonly known as hives, is a skin reaction pattern characterized by the appearance of itchy (pruritic), red (erythematous) raised welts or lumps called "wheals" on the skin. They usually occur in batches.

Urticaria that occurs in frequent, recurring episodes over a period of over 6 weeks is called chronic urticaria. In 80% of cases, the cause of urticaria is unknown (idiopathic) (Crawford); 3% of afflicted individuals have chronic idiopathic urticaria (Sheikh). Forty to sixty percent of individuals with chronic idiopathic urticaria have an autoimmune cause of their urticaria (Sheikh).

The three types of urticaria are categorized by cause: allergic, genetic (hereditary), and physical. Allergic urticaria is usually caused by medications; penicillin is the most common allergen. Virtually any drug can cause allergic urticaria. Aspirin can both cause urticaria, and worsen chronic urticaria in 21% to 41% of cases. Foods can commonly cause acute urticaria, but cause chronic urticaria only in about 2% of cases (Sheikh). Commonly implicated foods include nuts, fish, shellfish, eggs, milk, chocolate, tomatoes, and fresh berries. Inhalant allergens, especially pollens, mold spores, and animal danders frequently cause allergic urticaria. Allergic urticaria also results from infections (especially viral infections and streptococcal throat infections). Urticaria can be an allergic reaction to insect and spider bites, and develop from skin contact with chemicals, plants, and textiles. Hives may also develop after infections or illnesses (including autoimmune diseases and leukemia). A type of allergic urticaria also develops with some internal diseases, including rheumatoid arthritis, systemic lupus erythematosus (the initial symptom of the disease in 7% to 9% of individuals), and polymyositis.

A hereditary form of urticaria occurs, but is rare, accounting for only 2% of all cases of urticaria. This form usually affects the face, and often occurs after minor trauma such as dental work.

The third type of urticaria is physical urticaria, which results from physical factors such as heat, cold, and pressure, and comprises 71% of all cases of chronic urticaria (Habif). This type of urticaria usually affects young adults and only in the part of the body exposed to the physical stimulation; it is generally of short duration (30 to 60 minutes). The most common type of physical urticaria is called dermographism, which occurs at the site of scratching or under a tight garment. Another type of physical urticaria is "pressure urticaria," a painful, deep wheal occurring in areas of pressure such as feet, buttocks, and palms. Other, less common physical urticaria includes "cold urticaria" from exposure to cold and "solar urticaria" from sun exposure. A condition related to urticaria that is sometimes associated with it is "angioedema." This condition is similar to urticaria but involves the deeper dermis and subcutaneous tissue, and usually affects areas with loose subcutaneous tissue such as eyelids or lips.

Hives are more common in individuals who have experienced other allergic reactions, including hay fever and angioedema.

Incidence and Prevalence: Up to 15% to 20% of people in the US will have urticaria at some point in their lives (Crawford). Urticaria has roughly the same worldwide incidence as in the US.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Males and females are at equal risk to develop the condition. Females are more likely to develop chronic urticaria. It more commonly affects individuals in their forties and fifties.

Source: Medical Disability Advisor



Diagnosis

History: The individual will relate that red or red with pale center wheals (welts) have suddenly erupted on the skin, usually on limbs or trunk. The welts will blanch to the touch and will itch. Sometimes new welts will develop when the skin is scratched. The welts enlarge, spread, or join together to form large flat raised areas; they can change shape, disappear, and then reappear within minutes or hours.

Physical exam: The exam may reveal raised, red, batches of wheals on various parts of the body. Pressing down on the wheals will cause blanching, clearly identifying the erythematous nature of hives.

Tests: Baseline laboratory tests include CBC (complete blood count), erythrocyte sedimentation rate, multiphasic screening panel, and a RAST (radio allergosorbent) test for allergies. Other more specialized tests are done to diagnose specific types of urticaria, and may include skin tests (scratch and intradermal tests), skin biopsy, urinalysis, streptococcal throat culture, and tests for physical urticaria including warm water test, stroking test, and ice cube test. Other tests that may be helpful may include stool studies for fecal WBCs, ova, and parasites to rule out infection, antinuclear antibody (ANA) titer to rule out lupus, thyroid function tests, hepatitis B and C screen, prostate-specific antigens (PSA), and serum calcium.

Source: Medical Disability Advisor



Treatment

There is currently no known permanent cure for chronic idiopathic urticaria; most cases are characterized by periodic flare-ups with symptom-free intervals in between. Most of the time, the urticaria will eventually "burn out" and never return, although this may not happen for months or even years. Thus, symptomatic treatment is necessary. If the urticaria is an allergic reaction, the cause needs to be identified, removed, and avoided, if possible. Diet might need to be modified. Medications (plus their derivatives) need to be identified, avoided, and alternatives with similar therapeutic actions substituted. Factors that aggravate urticaria such as alcohol, aspirin, heat, exertion, and stress should be avoided. Cool compresses or soaks to irritated areas, soothing baths, and applying calamine lotion may calm the area, and reduce swelling and pain. Oral antihistamine medications often give quick relief, and are the most effective treatment, but frequently cause drowsiness. Epinephrine may be helpful when combined with antihistamines. A short course of systemic corticosteroid medication may be necessary in severe, resistant episodes of urticaria. The individual should avoiding inflaming the area, and avoid wearing tight clothing.

Source: Medical Disability Advisor



Prognosis

Most cases of urticaria resolve completely without complications. The wheals can last for several hours. Identifying and avoiding known trigger factors can help prevent allergic reactions in the future. Even if the trigger source cannot be identified, the allergic reactions can lessen in frequency and severity over time without treatment. In rare cases, a medical emergency may arise should severe anaphylaxis or severe respiratory tract angioedema develop; death is possible if that condition is not treated promptly. Even individuals with anaphylaxis, however, recover completely after treatment of the episode. Up to 20% of people with chronic urticaria can suffer with the disorder for longer than a decade (Sheikh).

Source: Medical Disability Advisor



Complications

Anaphylaxis and life-threatening airway obstruction, should swelling occur in the throat, may be associated with urticaria and constitute medical emergencies.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Antihistamines can cause drowsiness and sedation. Work that requires driving or operating heavy or dangerous equipment, or other situations where alertness is a safety issue may have to be restricted until treatment is completed. Also, if the urticaria results from exposure to a causative agent in the workplace, avoiding that agent will be necessary, and may require changing work areas.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual present with a skin reaction characterized by raised, red, itchy bumps?
  • Does individual have any known allergies?
  • Did individual report a recent change in diet, medication, cosmetics, soap, etc?
  • Was an underlying cause for the skin reaction determined with diagnostic tests, such as allergy testing, erythrocyte sedimentation rate (ESR), multiphasic screening panel?
  • If the diagnosis is uncertain, were conditions such as erythema multiforme or erythema nodosum ruled out?
  • Would individual benefit from consultation with a specialist (allergist, dermatologist, or immunologist)?

Regarding treatment:

  • Were antihistamines administered? Did the symptoms subside?
  • Was individual instructed to avoid offending allergen(s)?
  • Was diet counseling necessary?
  • Have medications or conditions (stress, heat, exertion) that could be associated with skin reactions been eliminated?
  • Has individual been compliant with the avoidance recommendations? If not, would additional counseling be beneficial?

Regarding prognosis:

  • Did the urticaria subside with treatment? If not, was further investigation done to rule out other skin irritants or causes?
  • Does individual have any underlying skin infections, connective tissue diseases, autoimmune disorders or other conditions that may impact recovery and prognosis? If so, are these conditions being addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

Crawford, Mary Beth. "Urticaria." eMedicine. Eds. Steven A. Conrad, et al. 19 Aug. 2004. Medscape. 26 Oct. 2004 <http://emedicine.com/emerg/topic628.htm>.

Habif, Thomas. Clinical Dermatology. 4th ed. New York: Mosby-Year Book, Inc., 2004. MD Consult. Elsevier, Inc. 26 Oct. 2004 <http://home.mdconsult.com/das/book/body/0/1195/1.html>.

Sheikh, Javed. "Urticaria." eMedicine. Eds. Richard F. Lockey, et al. 19 Nov. 2004. Medscape. 26 Oct. 2004 <http://emedicine.com/med/topic3014.htm>.

Source: Medical Disability Advisor






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