Is it urticaria?

Must be itchy, blanching, can be associated with angioedema, does not leave bruising

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