3
Acute, Chronic and Physical Urticaria
and Angioedema
Table 1. Causes of Acute Urticaria, Angioedema, or Both
Contact urticaria (e.g., plant or animal)
Early contact dermatitis (e.g., poison ivy or nickel)
Exacerbation of physical urticaria (e.g., dermographism or cholinergic urticaria)
Food allergies (IgE mediated)
Adverse reactions to allergen immunotherapy
Adverse medication reactions (e.g., opiates, ACE inhibitors, or NSAIDs)
Papular urticaria caused by insect sting/bite (e.g., scabies, fleas, or bed bugs)
Infection (e.g., parvovirus B19 or Epstein-Barr virus)
Food or envenomation/ingested toxin (e.g., scombroid)
Treatment
Î Epinephrine should be prescribed if the diagnosis of anaphylaxis
has not been excluded. (D)
Î In most cases antihistamines are efficacious for therapy of acute
urticaria and angioedema. (B)
Î In severe cases oral corticosteroids might be necessary to treat
acute urticaria and angioedema. In patients with poor response to
antihistamines, a brief course of oral corticosteroids might also
be required while attempting to eliminate suspected triggers and
develop an effective treatment plan. (C)