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Urticaria key points
Firstly think why your patient has urticaria it is often not an allergy:
Exogenous factors eg stress
Is the patient atopic? (more common in)
Mast cell egranulating rugs aspirin and NSAIDS penicillin opiates esp
codeine. Ask a!out sel" #edication as well as checking prescri!ed.
! ietary cause will "e usually "e o"#ious eg shellfish$ straw"erries "ecause
of rapi timing of association%
Infections$ often #iral are linke particularly in chilren
!llergy is less likely unless it is clear from the start&history%
'loo tests: ( F') an ifferential * platelets$ E+,% )onsier )- esterase an
complement if hereitary angioeema suspecte (rare "ut clusters locally)% .F.s$
autoanti"oies$ li#er tests may "e neee is suspecte%
.reatment
Non$sedati%e antihista#ine o" &our choice. Howe%er sedati%e antihista#ine can !e use"ul
at night. European guidelines sanction a trial o" up to four times the license aily ose
of a non(seating antihistamine% /i#e a long course of se#eral weeks&months for
mast cells to resta"ilise this is a slow process% (see http'//www.prodig&.clarit&.co.uk/urticaria(
H) receptor antagonists and #ontelukast can !e considered
+terois are not help"ul long ter# !ut o""er a !rie" respite "or i#portant e%ents * warn
patients o" a #ore intense "lare when the& are stopped and gi%e antihista#ine also
Most importantly Explain to your patient a"out urticaria it may nee larger oses
of antihistamine than normal recommenations for weeks to achie#e a response%
!#ise a"out not ri#ing&operating machinery after seati#e&partially seati#e
antihistamines%
http:&&www%patient%co%uk&health&!cute(Urticaria%htm
http:&&www%patient%co%uk&health&)hronic(Urticaria%htm
!uthor Dr Paul +err& , Dr -o!ert .raha#/ Consultant Der#atologist/ 0P1H
Dr Cli%e .rattan/ NN1H 23a& )45)(
Email paul.!err&6nhs.net
+ource Dr -o!ert .raha#/ Consultant Der#atologist/ 0P1H
0ate )7 0anuar& )45)
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