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Urticaria

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Principles of Management

Local clinicians recommend:

Primary Care Dermatology Society: Urticaria and angioedema clinical guidance

Most urticarial rashes lasting more than 6 weeks are due to Chronic Spontaneous Urticaria. This is not due to allergy and allergy testing and patch testing are not indicated - further details can be found here http://www.pcds.org.uk/clinical-guidance/urticaria-spontaneous-syn.-chronic-ordinary-urticaria

NICE Clinical Knowledge summaries highlight scenario based management. Managing Urticaria: https://cks.nice.org.uk/urticaria

Please see the following local guidelines:

Adults - Immunology & Allergy including managing Urticaria & Angiodema and when to refer

Please always refer to the BNSSG Formulary for the latest prescribing guidance.

Red Flags

Angio-oedema and anaphylaxis. Rapidly evolving angio-oedema (with or without anaphylaxis) is a medical emergency.

Stable angio-oedema without anaphylaxis may be managed in primary care – https://cks.nice.org.uk/angio-oedema-and-anaphylaxis

Urticarial vasculitis

Consider if individual urticarial lesions last longer than 24 hours, are painful more than itchy, and leave bruising/hyperpigmentation. See link for more details and consider referral to secondary care http://www.pcds.org.uk/clinical-guidance/urticarial-vasculitis

Urticaria Pigmentosa (also known as Maculopapular cutaneous mastocytosis) may also be included in the differential diagnosis of urticaria. There may be systemic involvement. So take a full history and consider referral if suspected. Further details are available at http://www.pcds.org.uk/clinical-guidance/mastocytosis

Patient information leaflet- https://www.bad.org.uk/pils/urticaria-pigmentosa/

Referral

Urticaria without complications can normally be diagnosed and managed in primary care using the guidhttps://www.bad.org.uk/pils/urticaria-pigmentosa/elines above.

If advice or confirmation of diagnosis is required then consider using Dermatology Advice and Guidance initially.

Sirona Community Dermatology Services offer treatment plans and education from Dermatology Specialist Nurses. Diagnosis confirmation and treatments can be provided by GPwSI. This is a non-urgent Service available via eRS or EMIS managed referral.

Secondary Care referral for Dermatology and/or Immunology and Allergy may be required for confirmation of diagnosis and management plan for more complex cases of urticaria- for example solar urticaria, or suspected complex food allergy.　

Patients with chronic spontaneous urticaria and/or angioedema should only be referred if symptoms are intolerable despite treatment – see management recommendations in the Immunology & Allergy Guidelines

Resources

British Association of Dermatologists PIL https://www.bad.org.uk/pils/urticaria-and-angioedema/

Allergy UK: https://www.allergyuk.org

Offering support for both Patients and Health Care Professionals. Fact sheets and keeping a symptom/food diary advice section. Also offering a helpline and online forum.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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