Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Urticaria - Management
Overview of management

  • Determine whether this is the first episode of urticaria or a recurrent/persistent presentation.
  • Assessment should involve:
    • The exclusion of angio-oedema (admission is needed if there is airway involvement). For more information, see the CKS topic on Angio-oedema and anaphylaxis.
    • Confirmation of the diagnosis of urticaria, and if possible identification of the cause.
  • If it is the first presentation of urticaria:
    • Reassure the person that acute urticaria is normally self-limiting, and is not serious or infectious.
    • Offer a non-sedating oral antihistamine (e.g. cetirizine, fexofenadine, or loratadine).
    • Consider an additional sedating antihistamine at night if the itch is interfering with sleep.
    • Consider an additional short course of oral prednisolone (e.g. 40 mg daily for 3–5 days) for generalised acute urticaria.
    • Follow-up is needed only if symptoms have not improved or are worsening.
  • If urticaria is persistent (chronic urticaria):
    • Advise the person about self-care and avoiding known trigger factors.
    • Continue treatment with a non-sedating antihistamine, or consider switching to a different one.
    • Consider an additional sedating antihistamine at night if the itch is interfering with sleep.
    • Topical menthol 1% cream can be used instead of, or in addition to, oral antihistamines.
    • Consider a short course of oral prednisolone (e.g. 40 mg daily 3–5 days) to control severe flare-ups.
    • Follow-up will depend on the frequency and severity of attacks.
  • Refer persistent urticaria (usually lasting beyond 6 weeks) that is still troublesome despite antihistamines, or is thought to be related to vasculitis or an acute allergy (e.g. peanut or latex).

© NHS Institute for Innovation and Improvement