Management of urticaria in General Practice
Sue Aquilina, Consultant Dermatologist & Krystle Ebejer, General Practice Trainee, Department of Dermatology, Sir Paul Boffa Hospital, Malta
Two typical cases of urticaria in an adult and child are presented. Making a diagnosis of urticaria is easy if one takes a good clinical history. The history is also used to check for any underlying triggers or aggravating factors, which should be removed where possible. The choice of investigations is discussed, but blood tests might not be needed if a patient responds well to oral antihistamines. Modern second-generation oral antihistamines are indicated as first-line symptomatic treatment, with updosing if necessary. Referral to a dermatologist is indicated when there is insufficient response to antihistamines, or if urticarial vasculitis is suspected. Systemic steroids may be needed in short rescue courses but long-term use should be avoided. Omalizumab is a new treatment option in patients who do not respond to oral antihistamines or second-line treatment options.
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