4
Figure 1. Diagnosis and Management of Acute Urticaria
Patient presents with possible acute urticaria and/or angioedema
DETAILED HISTORY INCLUDING REVIEW OF SYSTEMS
• Drug or biologic agent exposure(s)
• Food or contact (e.g. latex) exposure
• Stinging Insects
• Physical triggers - evaluate with visual analog scale and itch severity scale
• Infection and exposures, including travel history
• Co-morbid disorder
PHYSICAL EXAMINATION
• Extent and characteristics of the
urticaria/angioedema lesions
• Presence of dermatographism
• Thyromegaly
SPECIFIC
EVALUATION focused
on the evaluation
results above
MAY CONSIDER LIMITED NON-SPECIFIC
EVALUATION
Laboratory Diagnostics
• May include CBC with diff, ESR, TSH, renal
and liver profiles
• Additional testing may be necessary
depending on physician evaluation and patient
circumstances
Initial Treatment
• Remove/Avoid factors that may induce
urticaria/angioedema
• Antihistamines
• For moderate to severe cases: oral
glucocorticosteroids
• Epinephrine if potential for anaphylaxis
Management or
specific condition
improves urticaria?
Follow up in 2-6
weeks as symptoms
and treatment
response dictate:
Modify (step down or
discontinue) based on
clinical response
Is the general
evaluation listed
above suggestive of an
underlying cause?
Is specific
evaluation
suggestive of an
underlying
etiology?
NO
NO
NO
YES
YES
YES
Acute, Chronic and Physical Urticaria
and Angioedema
• Lymphadenopathy
• Fever
• Jaundice
• Organomegaly
• Presence of synovitis
Diagnostic Treatment
