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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)

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