• Advise people to reduce or avoid factors that are known to exacerbate their urticarial rash, that may include:
• Stress
• Alcohol, caffeine, spices, and hot water
• Some foods (e.g. fish, shellfish, nuts, cheese) and food additives (e.g. dietary salicylates, azo dyes, and benzoic acid).
• Food is often overestimated as a cause — in genuine food allergy, symptoms usually occur reproducibly within 60 minutes of exposure to the offending food. Food diaries may be helpful but can be hard to interpret.
• Overheating — keep the bedroom cool whilst sleeping and avoid hot baths.
• Tight clothing
• Medication — e.g. aspirin, codeine, nonsteroidal anti-inflammatory drugs (NSAIDs), and angiotensin-converting enzyme (ACE) inhibitors. Advise people not to use cold remedies or herbal preparations until the exacerbating factors have been excluded.
• Insect bites and stings — remove the stinger after a bee or wasp sting as soon as possible. Advise people to wear long-sleeved clothing and to avoid wearing bright colours or perfume.

• Stress is an important precipitant of urticaria. In one small non-randomized study, relaxation therapy and hypnosis improved self-reported symptoms but not the number of observed weals [Shertzer and Lookingbill, 1987].
• Diets and food avoidance remain controversial with very little evidence to support their benefit in people with urticaria [Zachariae et al, 1969; Kozel and Sabroe, 2005]. Food can usually be excluded as a cause of urticaria if there is no temporal relationship to a particular food trigger, either by ingestion or contact. In genuine food allergy, symptoms usually occur reproducibly within 60 minutes of exposure to the offending food [Powell et al, 2007].
• Alcohol, caffeine, spices, and hot water all cause vasodilation and may precipitate urticaria [Moses, 2003].
• Overheating commonly exacerbates itch, so advise keeping the bedroom cool at night whilst sleeping, and avoiding hot baths [Moses, 2003].
• Tight clothing should be avoided in delayed-pressure urticaria. This minimizes sweating which is thought to be an important precipitant of the symptom of itch [Yosipovitch et al, 2002].
• Medication — if possible avoid drugs such as aspirin (not contraindicated in urticaria but the reaction is dose-dependent), codeine, nonsteroidal anti-inflammatory drugs (NSAIDs), and angiotensin-converting enzyme (ACE) inhibitors. Advise people not to use cold remedies or herbal preparations until the exacerbating factors have been excluded [BAD, 2006]. For more information, see the CKS topic on Angio-oedema and anaphylaxis.

[Kozel and Sabroe, 2005]