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Urticaria - Management
What follow-up is recommended for recurrent or persistent urticaria?

  • Advise people to return if:
    • Their symptoms worsen.
    • There is no response to treatment after 2 weeks; try an alternative non-sedating antihistamine or reconsider the diagnosis.
  • If symptoms recur or persist for more than 6 weeks (and are still troublesome despite the use of antihistamines and avoidance of known trigger factors), consider referring to an immunologist or dermatologist for further management.
  • Any suggestion of angio-oedema will require admission to hospital or daily review until the symptoms resolve. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • After a referral, the follow-up of people with chronic urticaria will depend on the severity of symptoms, response to treatment, and impact on daily living.
Basis for recommendation
  • This is pragmatic advice based on expert opinion from the medical literature [Grattan et al, 2001].
  • Individuals vary in their response and tolerance to antihistamines. Therefore a switch in non-sedating antihistamine is useful if there is no response (e.g. within 2 weeks) to the initial antihistamine [Grattan et al, 2001; Zuberbier et al, 2006].
  • Non-sedating antihistamines are routinely increased beyond the recommended licensed dose in secondary care to control symptoms [Grattan et al, 2001; Zuberbier et al, 2006]; however, this is likely to increase the risk of adverse effects and there are few trial data that evaluate this approach. CKS recommends that it is not advisable to increase above the maximum dose, unless the healthcare professional has experience in doing so, or before seeking specialist advice.

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