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Urticaria

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Checked: 16-09-2025 by Rob Adams Next Review: 16-09-2027

Overview

Please see the following local guidelines:

Immunology & Allergy Guidelines - including managing Urticaria & Angiodema in adults (16 years and over) and when to refer.

Other national guidelines can also be helpful:

Urticaria and angioedema - and overview- primary care dermatology society. Links to specific pages on different types of urticaria and angioedema.
Spontaneous urticaria, chronic ordinary urticaria - 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.
Urticaria| CKS | NICE - NICE Clinical Knowledge summaries highlight scenario based management.

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

For allergy and urticaria in children please see the Allergy (children) section.

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 –Angio-oedema and anaphylaxis | CKS | NICE

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: Urticarial vasculitis (PCDS)

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. See the following for more details: Mastocytosis (PCDS)

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

Referral

Please review the Immunology & Allergy guidelines prior to referral or consider using Dermatology Advice and Guidance or Immunology & Allergy Advice and Guidance

Consider referral to Dermatology clinic via eRS if:

- required for confirmation of diagnosis and management plan for more complex cases of urticaria (e.g solar urticaria).

- history suggests delayed hypersensitivity or eczematous rash

- cutaneous urticaria associated with a vasculitis is suspected (refer as urgent)

Consider referral to Allergy (triage/RAS) clinic via eRS if:

- suspected complex food allergy.

- 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.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.