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Urticaria - Management
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Definition
- Urticaria is a localised or generalised superficial swelling of the skin (epidermis and mucous membranes) that results in an itchy rash.
What assessment do I need to make for a first episode of urticaria?
- Confirm the diagnosis and try to identify the underlying cause using a thorough history and examination.
- Exclude angio-oedema and anaphylaxis with systemic involvement (urgent admission needed) by examining the ears, nose, and throat; listening to the person's chest; measuring blood pressure and pulse. For more information see the CKS topic on Angio-oedema and anaphylaxis.
- Investigations are not usually required.
In depth
How should I treat a first episode of urticaria?
- Treatment is not needed if the episode is mild; acute urticaria is normally self-limiting, and is not serious or infectious.
- If symptomatic treatment is needed:
- Offer a non-sedating antihistamine to control daytime symptoms.
- Consider giving an additional sedative antihistamine at night if the itch is interfering with sleep.
- For severe symptoms:
- Give a short course of oral corticosteroids (e.g. prednisolone 40 mg daily for 3–5 days) in addition to the oral antihistamine.
- If rebound symptoms occur after a short course of corticosteroids seek specialist advice. Repeat courses of steroids are not recommended.
In depth
Which antihistamine should I use to treat urticaria?
- First choice: cetirizine, fexofenadine, or loratadine.
- Additional sedating antihistamine to aid sleep: chlorphenamine or hydroxyzine.
In depth
When should I refer someone with urticaria?
- Admit a person with urticaria and angio-oedema involving the airway and/or anaphylaxis. Start initial treatment with intramuscular adrenaline, if available.
- 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 a 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: suspect if lesions are painful and persistent.
In depth
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