Most patients with urticaria can be managed in Primary Care.
Stop any histamine releasing drugs, e.g. aspirin, codeine, ACE inhibitors, penicillin, non-steroidal anti-inflammatory drugs.
Causes of acute urticaria:
Detailed history may identify possible triggers e.g. medication Laboratory tests (IgE) are rarely necessary and only to confirm suspected specific triggers
SKIN PATCH TESTING IS INAPPROPRIATE
Treatment of acute urticaria: :
- Non-sedating antihistamines
- Sedating antihistamines: additionally at night if sleep disturbed
- Continue regular treatment until symptoms subside
Causes of chronic urticaria:
- Idiopathic
- Physical e.g. cold, pressure, dermographism
- Auto-immune aetiology
Treatment of chronic urticaria:
- Non-sedating antihistamines daily for 6 months
- Sedating antihistamines: additionally at night if sleep disturbed
- Topical antipruritic: 1% menthol in aqueous cream
Causes of angioedema:
- ACE inhibitors
- Idiopathic
- C1 esterase inhibitor deficiency is rare and specific treatment is required
Investigation of angioedema without urticaria:
Treatment of angioedema:
Non-sedating antihistamines