Acute Urticaria
Short-term hives evaluation including trigger identification and anaphylaxis screening.
Overview
Acute urticaria is defined as hives (wheals) and/or angioedema lasting less than 6 weeks. It's a common condition that can be triggered by various factors including allergies, infections, medications, and other causes.
symptoms
- Raised, itchy welts (hives) that appear suddenly
- Hives that come and go within hours
- Angioedema (swelling of deeper tissues, especially around eyes, lips, hands, feet)
- Itching or burning sensation
- Symptoms lasting less than 6 weeks
common Triggers
- Foods (nuts, shellfish, eggs, milk, etc.)
- Medications (antibiotics, NSAIDs, etc.)
- Infections (viral, bacterial, parasitic)
- Insect stings or bites
- Physical triggers (pressure, cold, heat, exercise)
- Stress or emotional factors
- Contact allergens (latex, plants, chemicals)
evaluation
history
- Detailed history of recent exposures (foods, medications, infections)
- Timing of symptom onset
- Duration and pattern of hives
- Associated symptoms (difficulty breathing, swelling, etc.)
- Recent illnesses or infections
- Medication history
physical
Assessment of hives distribution, angioedema, and signs of anaphylaxis
testing
- Limited testing for acute urticaria unless specific trigger is suspected
- Skin prick testing if food or environmental allergy is suspected
- Serum IgE testing for specific allergens if indicated
- Consider infection workup if history suggests (strep, viral, etc.)
anaphylaxis Screening
Always assess for signs of anaphylaxis: difficulty breathing, throat swelling, drop in blood pressure, dizziness, or loss of consciousness
treatment
immediate
- Remove or avoid identified trigger if known
- Oral antihistamines (second-generation H1 blockers preferred)
- Topical treatments (cool compresses, calamine lotion) for symptom relief
- Epinephrine if signs of anaphylaxis are present
medications
- Second-generation H1 antihistamines (cetirizine, loratadine, fexofenadine) - first line
- First-generation H1 antihistamines (diphenhydramine) - for severe itching, especially at night
- H2 antihistamines (ranitidine, famotidine) - may be added for refractory cases
- Oral corticosteroids - for severe or persistent cases, short course only
- Leukotriene receptor antagonists - may be helpful in some cases
duration
Most cases resolve within days to weeks. Treatment is typically needed only until symptoms resolve.
when To Refer
- Signs of anaphylaxis or severe angioedema
- Symptoms persisting beyond 6 weeks (becomes chronic)
- Recurrent episodes without clear trigger
- Severe symptoms not responding to standard treatment
- Concern for underlying systemic disease
prevention
- Avoid identified triggers
- Carry epinephrine auto-injector if food or insect sting allergy is confirmed
- Wear medical alert bracelet if severe allergy is identified
- Read food labels carefully if food allergy is suspected
- Inform healthcare providers of medication allergies
prognosis
Most cases of acute urticaria resolve spontaneously within days to weeks. Identifying and avoiding triggers can prevent recurrence. If symptoms persist beyond 6 weeks, it's considered chronic urticaria and requires different management.
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