Acute urticaria and angioedema: diagnostic and treatment considerations.
Urticaria is defined as wheals consisting of three features: (i) central swelling of various sizes, with or without surrounding erythema; (ii) pruritus or occasional burning sensations; and (iii) the skin returning to normal appearance, usually within 1-24 hours. Angioedema is defined as: (i) abrupt swelling of the lower dermis and subcutis; (ii) occasional pain instead of pruritus; (iii) commonly involving the mucous membranes; and (iv) skin returning to normal appearance, usually within 72 hours. Acute urticaria and angioedema is defined by its duration (<6 weeks) compared with chronic urticaria and angioedema. The most common causes are infections, medications, and foods. The best tools in the evaluation of these patients are a comprehensive history and physical examination. There are a variety of skin conditions that may mimic acute urticaria and angioedema and the various reaction patterns associated with different drugs. Oral antihistamines are first-line treatment. In the event of a life-threatening reaction involving urticaria with angioedema, epinephrine may be needed to stabilize the patient. This review focuses on the value of a comprehensive clinical evaluation at the onset of symptoms. It underscores the importance of coordination of care among physicians, and the development of an action plan for evidence-based investigations, diagnosis, and therapy.
Frigas
Evangelo
E
Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. frigas.evangelo@mayo.edu
Park
Miguel A
MA
D000208:Acute Disease; D018663:Adrenergic Agents / Q000008:administration & dosage; D000799:Angioedema / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics; D015984:Causality; D050718:Complement C1 Inhibitor Protein / Q000378:metabolism / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D020022:Genetic Predisposition to Disease; D005938:Glucocorticoids / Q000008:administration & dosage; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage; D011379:Prognosis; D014581:Urticaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
D018663:Adrenergic Agents; D050718:Complement C1 Inhibitor Protein; D005938:Glucocorticoids; D006633:Histamine Antagonists; D020024:Leukotriene Antagonists; D004837:Epinephrine