Diagnostic tips

• Itchy red wheals occurring or recurring in crops
• Transient nature usually resolving in hours
• No residual scarring or bruising
• Elicitation of dermographism
• Possible coexistence of angioedema

Therapeutic tips

• Advise patient to avoid suspected triggers: stress, heat, tight clothing, alcohol, caffeine.
• Stop any histamine releasing drugs eg: aspirin, codeine, ACE inhibitors, penicillin, non-steroidal anti-inflammatory drugs
• Change to alternative anti-histamine after 4-6 weeks if one agent has not helped.
• Consider combination of two drugs. Antihistamine administration should be related to the time pattern of symptoms.
• Avoid long term oral steroids in chronic urticaria.

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