Is it urticaria?
Must be itchy, blanching, can be associated with angioedema, does not leave bruising.
Click here for Urticaria Assessment Score.
Obvious trigger? typically less than 60 min ago e.g. food, animal dander, dust, pollen
Avoid allergen
Prescribe long-acting antihistamine e.g. cetirizine or loratidine (usually does not need steroids or adrenaline)
Confirm with allergy tests
No obvious trigger? consider infection or if chronic for more than 6 weeks
Daily long-acting antihistamine
Chronic urticaria not responsive to daily antihistamine
Increase dose of long-acting antihistamine 2 to 4 fold
Add montelukast
Education – provide chronic urticaria leaflet
Refer to specialist if
Associated with bruising – ?vasculitis
Angioedema only, particularly if family history ?hereditary angioedema
Not responsive to step 3 or atypical