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Urticaria - Management
When should I refer someone with urticaria?
- Admit a person with angio-oedema involving the airway and/or anaphylaxis. Start initial treatment with intramuscular adrenaline, if available. See the CKS topic on Angio-oedema and anaphylaxis.
- Refer to an immunologist or dermatologist when there is:
- Urticaria with angio-oedema not involving the airway.
- Acute urticaria which is severe and thought to be due to adverse drug reactions, or food or latex allergy.
- Chronic persistent urticaria (usually lasting beyond 6 weeks) which is troublesome despite the use of antihistamines and avoidance of known trigger factors.
- Vasculitic urticaria: this may be suspected if lesions are persistent and painful.
- Referral will depend on local policy and services available.
Basis for recommendation
- These recommendations are based on pragmatic advice from expert opinion. However, local referral pathways may vary.
- A skin biopsy is essential to confirm the presence of small-vessel vasculitis histologically [Grattan et al, 2007].
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