Treatment Guideline Chart
Urticaria is characterized by sudden appearance of wheals and/or angioedema.
The intensity of the pruritus varies but may be severe enough to disrupt sleep, work or school.
It is classified acute if the urticaria has been present for <6 weeks and chronic if >6 weeks. A specific cause is more likely to be identified in acute cases.
It can be triggered by immunological or nonimmunological mechanism.

Urticaria References

  1. Kennedy MS. Comprehensive care in the allergy/asthma office: evaluation of chronic eczema and urticaria and angioedema. Immunol Allergy Clin North Am. 1999;19(1):19-33
  2. Alper BS. Choice of antihistamines for urticaria. Arch Fam Med. 2000 Aug;9(8):748-751. PMID: 10927716
  3. Baxi S, Dinakar C. Urticaria and angioedema. Immunol Allergy Clin North Am. 2005 May;25(2):353-367. PMID: 15878460
  4. Amar SM, Dreskin SC. Urticaria. Prim Care. 2008 Mar;35(1):141-157. doi: 10.1016/j.iac.2005.03.003. PMID: 18206722
  5. Blauvelt A, Hwang ST, Udey MC. Allergic disorders: allergic and immunologic diseases of the skin. J Allergy Clin Immunol. 2003 Feb;111(2 Suppl):S560-S570. PMID: 12592302
  6. Chow SK. Management of chronic urticaria in Asia: 2010 AADV consensus guidelines. Apr 30, 2012. Asia Pac Allergy. 2012 Apr;2(2):149-160. doi: 10.5415/apallergy.2012.2.2.149. Accessed 16 Sep 2013. PMID: 22701866
  7. Grattan C, Humphreys F; British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Guidelines for evaluation and management of urticaria in adults and children. Br J Dermatol. 2007 Dec;157(6):1116-1123. PMID: 18021095
  8. Grattan C, Powell S, Humphreys F. Management and diagnostic guideines for urticaria and angioedema. Br J Dermatol. 2001 Apr;144(4):708-714. PMID: 11298527
  9. Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000 Apr;105(4):664-672. PMID: 10756214
  10. Grattan CE, Sabroe RA, Greaves MW. Chronic urticaria. J Am Acad Dermatol. 2002 May;46(5):645-657. PMID: 12004303
  11. Kaplan A. Clinical practice. Chronic urticaria and angioedema. N Engl J Med. 2002 Jan;346(3):175-179. PMID: 11796852
  12. Greaves MW. Antihistamines. Dermatol Clin. 2001 Jan;19(1):53-62. PMID: 11155586
  13. Konstantinou GN, Asero R, Ferrer M, et al. EAACI taskforce position paper: evidence for autoimmune urticaria and proposal for defining diagnostic criteria. Allergy. 2013 Jan;68(1):27-36. doi: 10.1111/all.12056. PMID: 23157716
  14. Monroe E, Finn A, Patel P, et al. Efficacy and safety of desloratadine 5 mg once daily in the treatment of chronic idiopathic urticaria. J Am Acad Dermatol. 2003 Apr;48(4):535-541. PMID: 12664016
  15. Leung DY, Boguniewicz M. Advances in allergic skin diseases. J Allergy Clin Immunol. 2003 Mar;111(3 Suppl):S805-S812. PMID: 12618747
  16. Muller BA. Urticaria and angioedema: a practical approach. Am Fam Physician. 2004 Mar;69(5):1123-1128. PMID: 15023012
  17. Poonawalla T, Kelly B. Urticaria - a review. Am J Clin Dermatol. 2009;10(1):9-21. doi: 10.2165/0128071-200910010-00002. Accessed 21 Jan 2011. PMID: 19170406
  18. Nichols K, Cook-Bolden F. Allergic skin disease: major highlights and recent advance. Med Clin Am. 2009 Nov;93(6):1211-1224. doi: 10.1016/j.mcna.2009.08.004. PMID: 19932327
  19. Zuberbier T. A Summary of the New International EAACI/GA(2)LEN/EDF/WAO Guidelines in Urticaria. World Allergy Organ J. 2012 Jan;5(Suppl 1):S1-S5. doi: 10.1097/WOX.0b013e3181f13432. PMID: 23268477
  20. Zacharisen MC. Pediatric allergy and immunology: pediatric urticaria and angioedema. Immunol Allergy Clin North Am. 1999 Dec;19(2):363-382. doi: 10.1016/S1081-1206(10)62866-9. PMID: 10619346
  21. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EACCI/GA2LEN/ EDF/WAO guideline: management of urticaria. Allergy. 2009 Oct;64(10):1427-1443. doi: 10.1111/j.1398-9995.2009.02178.x. PMID: 19772513
  22. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EACCI/GA2LEN/ EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009 Oct;64(10):1417-1426. doi: 10.1111/j.1398-9995.2009.02179.x. PMID: 19772512
  23. Zuberbier T, Maurer M. Urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm Venerol. 2007;87(3):196-205. PMID: 17533484
  24. Habif TP. Urticaria. Clinical Dermatology. 5th ed. Pennsylvania: Mosby, Elsevier; 2010
  25. MedWormhttp://www.medworm.com/rss/index.php/Allergy-%26-Immunology/3/http://www.medworm.com/rss/medicalfeeds/specialities/Allergy-Immunology.xml
  26. MedWorm http://www.medworm.com/rss/index.php/Dermatology/12/ http://www.medworm.com/rss/medicalfeeds/specialities/Dermatology-News.xml
  27. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  28. Khan DA. Chronic urticaria: standard management and patient. UpToDate. http://www.uptodate.com/online/content/topic.do?topicKey=urticari/6548&selectedTitle=4%7E150&source=search_result. Sep 2010. Accessed 20 Dec 2010.
  29. Khan DA. Chronic urticaria: treatment of refractory symptoms. UpToDate. http://www.uptodate.com/contents/chronic-urticaria-treatment-of-refractory-symptoms#H5.August. Aug 2013. Accessed 16 Sep 2013.
  30. Bingham C. New onset urticaria: epidemiology, clinical manifestations, and etiologies. UpToDate. http://www.uptodate.com/. Sep 2010. Accessed 20 Dec 2010.
  31. American Academy of Allergy, Asthma and Immunology. Omalizumab: well tolerated and effective in refractory chronic idiopathic/spontaneous urticaria. https://www.aaaai.org/. Jul 2013. Accessed 16 Sep 2013.
  32. Linscott MS, Crawford MB. Urticaria. eMedicine. http://www.emedicine.com/emerg/topic628.htm.Monroe. Accessed 12 Jun 2006.
  33. Powell RJ, Leech SC, Till S, et al; British Society for Allergy and Clinical Immunology. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015 Mar;45(3):547-565. doi: 10.1111/cea.12494. PMID: 25711134
  34. Antia C, Baquerizo K, Korman A, et al. Urticaria: A comprehensive review. J Am Acad Dermatol. 2018 Oct;79(4):617-633. doi: 10.1016/j.jaad.2018.01.023. PMID: 30241624
  35. Asero R. New-onset urticaria. UpToDate. http://www.uptodate.com. 2019.
  36. Khan DA. Chronic spontaneous urticaria: Standard management and patient education. UpToDate. http://www.uptodate.com. 2019.
  37. Khan DA. Chronic spontaneous urticaria: Treatment of refractory symptoms. UpToDate. http:// www.uptodate.com. 2019.
  38. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-1414. doi: 10.1111/all.13397. PMID: 29336054
  39. Zuberbier T, Bernstein JA. A comparison of the United States and international perspective on chronic urticaria guidelines. J Allergy Clin Immunol Pract. 2018 Jul;6(4):1144-1151. doi: 10.1016/j.jaip.2018.04.012. PMID: 29779967
  40. Zuberbier T, Bindslev-Jensen C, Canonica W, et al. EAACI/GA2LEN/EDF guideline: definition, classification and diagnosis of urticaria. Allergy. 2006 Mar;61(3):316-320. PMID: 16436140
  41. Australasian Society of Clinical Immunology and Allergy (ASCIA). Position paper - chronic spontaneous urticaria (CSU). ASCIA. https://www.allergy.org.au/. 2020.
  42. Maurer M, Eyerich K, Eyerich S, et al. Urticaria: Collegium Internationale Allergologicum (CIA) update 2020. 32224621. 2020 Mar;181(5):321-333. doi: 10.1159/000507218. PMID: 32224621
Editor's Recommendations
Special Reports