Materiały źródłowe

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Urticaria is caused by immunoglobulin E- and nonimmunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. […] The mainstay of treatment is avoidance of triggers, if identified. […] Second-generation H1 antihistamines are safe and effective symptomatic therapy for urticaria. […] If needed to control symptoms of urticaria, second-generation H1 antihistamines can be titrated to two to four times the normal dose. […] A short course of systemic corticosteroids may help control severe cases of urticaria. […] The mainstay of treatment is avoidance of identified triggers. […] It is also recommended that patients avoid using aspirin, alcohol, and NSAIDs, as well as avoid wearing tight clothing, because these may worsen symptoms. […] If trigger avoidance is impossible, no trigger is identified, or symptom relief is needed despite trigger avoidance, H1-antihistamines are first-line pharmacotherapy.

• #1 Hives and angioedema | Altru Health System

  https://www.altru.org/health-library/conditions/hives-and-angioedema

  Hives and angioedema are usually treated with antihistamine medication. Angioedema can be life-threatening if swelling of the tongue or in the throat blocks the airway. […] To lower your likelihood of experiencing hives or angioedema, take the following precautions: […] Avoid known triggers. If you know what has triggered your hives, try to avoid that substance. […] Bathe and change your clothes. If pollen or animal contact has triggered your hives in the past, take a bath or shower and change your clothes if you’re exposed to pollen or animals.

• #1

  https://www.healthxchange.sg/head-neck/skin-health/hives-urticaria-angioedema-how-to-prevent

  How to prevent urticaria: 2 triggers to avoid […] Avoid NSAIDs painkillers. Don’t take NSAIDs painkillers like aspirin and ibuprofen. If you need pain relief at home, choose non-NSAIDs painkillers like paracetamol (Panadol) and Tylenol instead. […] If you have angioedema due to food such as shellfish, peanuts, tree nuts, eggs, and milk, you should stop consuming them. […] Hives and angioedema can happen when you are exposed to certain triggers.

• #1 Definition, classification and treatment of urticaria

  https://allerg.qc.ca/Information_allergique/4_3_urticaire_en.html

  Urticaria, commonly known as hives, is a skin condition marked by itchy, swollen patches of various sizes. […] When the swelling extends to deeper layers of the skin, it is called angioedema. Angioedema develops in up to half of those with hives. Both conditions can manifest simultaneously. […] Sometimes, it represents an actual allergic reaction caused by a food, a medication, an insect sting, or another sensitizing agent. […] If you suddenly develop hives or angioedema along with other symptoms such as trouble breathing, tightness in the throat, nausea or vomiting, cramping abdominal pain, or passing out, you should seek medical attention as soon as possible. […] Avoid factors that evoke the physical urticarias, such as excessive heat, the sun, tight clothing or irritants, etc. […] Avoid vasodilatory factors which may potentialize urticaria, such as alcohol, nicotinic acid, anti-inflammatories, several anti-hypertensive medications and diverse food „irritants” (such as acidic foods, spices, fermented foods and charcuterie). […] Treat, if possible, any disease that may cause the urticaria (secondary urticaria or angioedema).

• #1 Urticaria and Angioedema: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0301/p1123.html

  Urticaria (i.e., pruritic, raised wheals) and angioedema (i.e., deep mucocutaneous swelling) occur in up to 25 percent of the U.S. population. […] The mainstay of therapy for urticaria is avoidance of known triggering agents, judicious use of oral corticosteroids, and treatment with long-acting second-generation antihistamines, H2-receptor antagonists, tricyclic antidepressants, and anti-inflammatory leukotriene antagonists. […] Patients should be advised to avoid alcoholic drinks and over-the-counter drugs such as aspirin or nonsteroidal anti-inflammatory drugs because they may aggravate the condition. […] The mainstay of therapy for acute urticaria is a long-acting, nonsedating histamine H1-receptor antagonist such as fexofenadine (Allegra-D), desloratadine (Clarinex), or loratadine (Claritin).

• #1 Hives: Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/8630-hives

  Your healthcare provider can use the results of allergy tests to help you figure out which substances bring on acute hives. Once you know your triggers, you can avoid them. You may want to: […] It may not be possible to prevent chronic hives. Your provider may not be able to find exactly what causes them. They may also be a part of a bigger medical condition that affects your immune system. […] For some people, allergic reactions like angioedema can cause anaphylaxis severe swelling of the airways and lungs. If you have this life-threatening condition, you should carry and know when and how to use injectable epinephrine (EpiPen).

• #1 Urticaria and Angioedema – Information for Parents and Carers | Hull University Teaching Hospitals NHS Trust

  https://www.hey.nhs.uk/patient-leaflet/urticaria-and-angioedema/

  The most commonly used medications for urticaria and angioedema are antihistamines. These can be used at the start of an attack to reduce the itching, rash and swelling. […] If the urticaria or angioedema occurs frequently then antihistamines are best taken every day to prevent attacks. For those with recurrent urticarial and angioedema antihistamines can be safely taken for prolonged periods of months or even years. […] If there is not any urticaria or angioedema for several weeks when taking antihistamines then it is worth stopping the medication to see if they are still needed. If the urticaria/angioedema returns, the antihistamine should be restarted.

• #1 Practical Management of New-Onset Urticaria and Angioedema Presenting in Primary Care, Urgent Care, and the Emergency Department

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8784078/

  A new episode of urticaria and/or angioedema can be an anxiety-inducing event for both the patient and the physician(s) seeing them in primary care, urgent care, or the emergency department. […] Allergy is almost never the cause of a new episode of urticaria and/or angioedema in older children or adults presenting in primary care, urgent care, or the emergency department. […] The essential elements for the management of newly presenting urticaria are displayed in Figure 1. The treatment of choice for both the itching and the hives associated with both acute and chronic urticaria is a high-dose nonsedating antihistamine, typically cetirizine up to 40 mg. […] An epinephrine injector is rarely indicated in patients with acute idiopathic urticaria or chronic urticaria, with or without angioedema.

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Second-generation H1 antihistamines are first-line medication for the treatment of acute urticaria. […] In severe cases, corticosteroids such as prednisone or prednisolone (0.5 to 1 mg per kg per day) may be added for three to 10 days to control symptoms. […] Treatment of acute angioedema is largely the same as treatment for urticaria, although corticosteroids may be more commonly recommended. […] Most of the data on treatment of urticaria involve chronic cases. […] Current guidelines suggest a stepwise approach to treating chronic idiopathic urticaria. […] If first-line treatment is insufficient, the second step is implementation of one or more of the following additional strategies: the second-generation H1 antihistamine can be titrated up to two to four times the usual dose; a different second-generation H1 antihistamine can be added; first-generation H1 antihistamines may be added at nighttime; H2 antihistamines may be added; and leukotriene receptor antagonists can also be added.

• #1 Urticaria and Angioedema Treatment | IntechOpen

  https://www.intechopen.com/chapters/55133

  H1 antihistamines are usually effective in the majority of urticaria and/or angioedema patients but might be insufficient in some patients. […] Treatment of urticaria and/or angioedema mainly consist of antihistamines, short courses of corticosteroids, other immunosuppressive, and antiinflammatory agents. […] Systemic corticosteroids are frequently used for refractory patients with urticaria and might be considered in some patients for only shorttime use. […] Alternative therapies including omalizumab are approved by the Food and Drug Administration (FDA) for patients with chronic refractory urticaria and cyclosporine. […] Fresh frozen plasma, C1 inhibitor, and bradykinin receptor antagonist appear to be safe and effective therapeutic options for the management of ACEI-induced angioedema.

• #1 Urticaria and Angioedema – Journal of Urgent Care Medicine

  https://www.jucm.com/urticaria-and-angioedema-2/

  The treatment of infection-related urticaria is treatment of the underlying infection; usually, the hive response abates in 48 to 72 hours. […] Urticaria is frequently the presenting sign, even before thyroid function is abnormal. […] This form of urticaria can be difficult to control, but maybe helped by treating hypothyroidism if present, and may spontaneously remit over months or years. […] Oral antihistamines should never be prescribed for prn use, since they are preventative by occupying the H1 histamine receptor. […] Similarly, oral corticosteroids are usually very effective for treating urticaria and angioedema, and their failure implies a complicated or severe form of the disease. […] It is appropriate for the urgent care provider to refer the patient on oral antihistamines or a short burst of corticosteroid back to their primary physician. […] If an allergic cause is strongly suspected, then referral to an allergist may be appropriate. […] It is very helpful to reassure them that much of the time a cause can be found and it is usually benign—and, more importantly, that the symptoms can be controlled.

• #1 What’s New in the Treatment of Urticaria and Angioedema – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34112473/

  Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. […] In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. […] Optimal management of mast cell-mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. […] Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.

• #1 Everything You Need to Know About Urticaria

  https://www.arkansasdermatology.com/about/news-updates/everything-you-need-to-know-about-urticaria

  Identification of causative allergens, from the clinical history and blood testing or skin testing will enable the individual with urticaria and angioedema to avoid flares. […] Acute attacks of urticaria or angioedema can be treated with H1 antihistamines, such as Claritin, Zyrtec, or Allegra. […] If urticaria and angioedema have occurred previously resulting in a systemic anaphylaxis reaction, the patient should be prescribed an Epinephrine pen to always carry. […] Patients that have little or no relief with using antihistamines can be treated judiciously with corticosteroids. […] When the response to antihistamines is unsatisfactory, the agent of choice is Omalizumab (Xolair) administered as a 150 mg or 300 mg subcutaneous injection monthly in the Dermatology office. […] We know that antihistamines successfully treat 45% of hives patients, and Xolair is successful in treating the remaining 55%, then it is estimated that both drugs should be effective in about 83% of patients with CSU. […] Corticosteroids can be used acutely, but not chronically, for particularly severe episodes.

• #1 Urticaria and Angioedema: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0301/p1123.html

  Patients with a history of urticaria and angioedema or isolated angioedema episodes should be prescribed epinephrine in an auto-injectable instrument (EpiPen) in a dosage of 0.3 mg given intra-muscularly in the thigh and be instructed in its proper use for laryngeal edema, bronchospasm, and hypotension. […] Investigative treatment using immunomodulatory therapies such as cyclosporine, plasmapheresis, and intravenous immunoglobulin have been shown to be beneficial in autoimmune chronic urticaria.

• #1 Practical Management of New-Onset Urticaria and Angioedema Presenting in Primary Care, Urgent Care, and the Emergency Department

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8784078/

  All patients with chronic urticaria, daily hives lasting more than 6 weeks, should be referred to Allergy for long-term follow-up and to determine if an additional therapy such as omalizumab (anti-IgE) may be warranted. […] When angioedema presents without itching or hives, it is often bradykinin mediated. […] There is typically no effective treatment for a newly presenting case of angioedema, unless it has been confirmed to be from HAE or AAE, a complement system defect. […] Epinephrine, antihistamines, and systemic steroids do not help idiopathic or bradykinin-mediated angioedema and can have severe side-effects. […] The most useful treatment is watchful waiting, maintaining the airway, discontinuation of the implicated ACE inhibitor, and allowing normal homeostasis to return. […] There are now a variety of drugs approved for the prevention bradykinin-mediated angioedema, including C1-INH concentrates, the bradykinin B2-receptor antagonist, icatibant, and the kallikrein inhibitors, ecallantide, lanadelumab, and berotralstat, all of which are managed by the allergy department.

• #1 Urticaria and angioedema | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0288-z

  Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). […] The mainstay of management for angioedema is to avoid specific triggers, if possible. For hereditary angioedema, there are specifically licensed treatments that can be used for the management of acute attacks, or for prophylaxis in order to prevent attacks. […] Although the angioedema associated with these disorders is often self-limited, laryngeal involvement can lead to fatal asphyxiation. […] Short-term prophylaxis (STP) refers to the practice of treating patients to reduce the risk of associated and consequent morbidity and mortality during a period of time when there may be an increased risk of having an attack of angioedema. […] LTP should be considered in patients with HAE and AAE when their attack frequency and severity are not adequately controlled with acute therapy alone.

• #1 Urticaria and angioedema | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-7-S1-S9

  Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). […] The management of HAE and AAE involves both prophylactic strategies to prevent attacks of angioedema (i.e., trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy) as well as pharmacological interventions for the treatment of acute attacks (i.e., C1 inhibitor replacement therapy, ecallantide and icatibant). […] Prophylactic therapy should be considered in patients who experience more than one severe attack per month, or if treatment for acute episodes is not sufficiently effective or is not available. Therapeutic options include: trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy.

• #1 Urticaria & Angioedema | AMBOSS Rotation Prep

  https://resident360.amboss.com/pediatrics/pediatric-allergy-immunology/urticaria-angioedema/urticaria-angioedema.html

  Urticaria can be classified as acute or chronic, depending on the duration of symptoms: […] If a trigger is identifiable, avoidance is the first step. […] Omalizumab is a monoclonal antibody that targets IgE and is approved for use in chronic idiopathic urticaria refractory to high-dose antihistamines in patients aged 12 years and older. […] HAE prophylaxis options include the following: purified C1-inhibitor concentrate, available for prevention of attacks in an IV and subcutaneous preparation. […] Oral berotralstat (plasma kallikrein inhibitor); FDA approved in December 2020.

• #1 Angioedema – Wikipedia

  https://en.wikipedia.org/wiki/Angioedema

  In allergic angioedema, avoidance of the allergen and use of antihistamines may prevent future attacks. […] Future attacks of HAE can be prevented by the use of androgens such as danazol, oxandrolone or methyltestosterone. […] In 2018, the U.S. Food and Drug Administration approved lanadelumab, an injectable monoclonal antibody, to prevent attacks of HAE types I and II in people over age 12.

• #1 Urticaria and angioedema – UpToDate

  https://www.uptodate.com/contents/table-of-contents/dermatology/urticaria-and-angioedema

  Hereditary angioedema (due to C1 inhibitor deficiency): General care and long-term prophylaxis […] Hereditary angioedema: Short-term prophylaxis before procedures or stressful events to prevent angioedema episodes

• #1 Angioedema: Causes, Symptoms, Types & Treatments

  https://my.clevelandclinic.org/health/diseases/22632-angioedema

  If you have allergy-related angioedema, you can prevent occurrences by avoiding the food, medication or other triggers that cause allergic reactions. […] If you have non-allergic angioedema as a drug reaction to taking ACEIs, youll need to work with your healthcare provider to find another medication.

• #1

  https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/allergy/urticaria_and_angioedema

  Urticaria and angioedema may be allergic or non-allergic (spontaneous). In spontaneous urticaria/angioedema there may be exacerbating factors (eg heat, cold, pressure, stress, some medications). […] Patients with troublesome symptoms (rash or swelling) despite high dose prophylaxis with non-sedating antihistamines (3-4x/day). […] Spontaneous urticaria and angioedema should be treated initially with non-sedating antihistamines. […] Treatment may be as required or prophylactic depending on symptom frequency of symptoms. […] Higher than licensed doses may be required (eg cetirizine 10mg or fexofenadine 180mg up to 4x/day). […] Long term regular corticosteroids are not advised. […] All patients with angioedema should avoid ACE inhibitors. […] Patients with urticaria and/or angioedema should be advised to use NSAIDS with caution.

• #1

  https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/allergy/urticaria_and_angioedema

  No investigations are routinely indicated, and should only be performed if there is a specific indication. The exception is complement C4 levels in angioedema alone. […] ACE inhibitor treatment can cause angioedema (without urticaria) even after months or years of treatment and must be stopped in patients presenting with angioedema. […] Angioedema in the absence of urticaria also raises the possibility of hereditary/acquired angioedema; check complement C4 to exclude this.

• #1 Urticaria Treatment & Management: Approach Considerations, Consultations, Prevention of Urticaria

  https://emedicine.medscape.com/article/762917-treatment

  Patients with acute urticaria should avoid any medication, food, or other allergen that has precipitated urticaria (hives) or other serious allergic reaction previously. Chronic urticaria is seldom related to food allergens, and complicated elimination diets are seldom of benefit. […] If the patient has angioedema that is treated successfully in the ED, the patient should be sent home with an EpiPen prescription and told to keep it with him or her at all times and to use it if swelling of the lips, tongue, face develops or if his or her voice acutely become hoarse.

• #1 Angioedema: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000846.htm

  Hives and angioedema may also occur after infections. Angioedema may occur alone or with other illnesses (including autoimmune disorders such as lupus, leukemia, and lymphoma). […] People with angioedema should: Avoid any known allergen or trigger that causes their symptoms. Avoid any medicines, herbs, or supplements that are not prescribed by a provider. […] If the person has trouble breathing, seek medical help right away. A severe, life-threatening airway blockage may occur if the throat swells.

• #1 Urticaria and Angioedema – Journal of Urgent Care Medicine

  https://www.jucm.com/urticaria-and-angioedema-2/

  Patients often present to urgent care with symptoms associated with urticaria and angioedema. […] The goals of management are to identify the likely cause(s), and to eliminate the urticaria or, when that is not possible, to alleviate the symptoms. […] In most cases, the goal for urgent care is to initiate treatment and prescribe sufficient medications to get the person to their primary physician. […] The treatment of infection-related urticaria is treatment of the underlying infection; usually, the hive response abates in 48 to 72 hours. […] I believe that the steroids suppressed the allergic swelling in the sinuses and nasal passages and she was able to recover from infection on her own, but this is not the rule. […] In most patients with steroid refractory urticaria you should think of occult infection, usually in the sinuses.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/urticaria/comments/176five/chronic_urticaria_angioedema_for_3_years_my_story/

  I’ve had chronic urticaria/angioedema for the last three years and 2 months ago to the day I woke up hive free for the first time. […] After 18 months taking cetrinizine with no effect, and after blowing a lot of money on consultants who were as stumped as me, I finally said screw it – this isn’t working. So I stopped all the anti-histamines and started researching myself. […] So I stopped drinking alcohol, and that helped but didn’t get rid of them. […] my research led me to the following as potentially having some effect on immune system and histamine response: Lions mane mushroom, Chaga mushroom, Cordyceps mushroom, Ashwagandha root, Rhodiola Rosea. […] Started taking them, and 2 weeks later I woke up urticaria free. 2 weeks after that and no more angioedema. […] Currently, I’m taking the supplements every day but 2/3 the dosage the bottles recommend, I’m still drinking the odd alcoholic drink, and still get the odd hive but I could count on one hand the amount I get. Angioedema completely gone and I’ve started the gym – squatting 60kg on my back with zero swelling after. […] I’m aware that this might be fluke or coincidence, and please this is not medical advice, but maybe someone out there can be inspired to keep going because there is light at the end of the tunnel.

• #1 Hives and Angioedema I Ohio State Medical Center

  https://wexnermedical.osu.edu/ear-nose-throat/allergy-immunology-care/hives-and-angioedema

  Hives and angioedema are skin conditions caused by an allergy. […] Hives are commonly caused by an allergic reaction to medicines, foods, insect stings or bites, and skin contact reactions to certain materials such as latex, but oftentimes the cause is undetermined, and the hives may never happen again. […] Similar to hives, angioedema can be caused by an allergic reaction to insect stings, food, animal dander and skin contact allergens. […] When the trigger is identified, a lifestyle change may be necessary to avoid future contact. […] In addition, people with angioedema should avoid any known allergens or triggers that cause their symptoms and avoid any medicines, herbs, or supplements that are not prescribed by their Ohio State Wexner Medical Center physician.

• #1 Hives (Urticaria) | Causes, Symptoms & Treatment

  https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/

  Hives Management and Treatment: Avoid known triggers. See an allergist, who is specially trained to look for triggers to your hives and may recommend medications to prevent the hives or reduce the severity of symptoms. Whether your allergist suggests a treatment available only by prescription or an over the counter treatment will depend on several factors, including how uncomfortable the hives are making you. […] If your hives last more than a month or if they recur over time, see an allergist, who will take a history and perform a thorough physical exam to try and determine the cause of your symptoms. A skin test and challenge test may also be needed to identify triggers. […] Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives. They work by blocking the effect of histamine, a chemical in the skin that can cause allergy symptoms, including welts. Antihistamines that don’t make you drowsy are preferred.

• #1 Angioedema – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/skin-allergy/angioedema

  Angioedema is a condition where small blood vessels leak fluid into the tissues under the skin, causing swelling in different parts of the body. […] It is possible to develop angioedema without also developing hives. […] There is no known cure, but with the right diagnosis and management with appropriate medication, it can usually be prevented. […] Severe throat swelling requires the early use of medication (adrenaline for anaphylaxis or medication for HAE) followed by immediate transfer to hospital by ambulance. […] People with repeated angioedema should be referred by their doctor to a clinical immunology/allergy specialist for diagnosis and management. […] Avoid the triggers that make symptoms worse. It may be possible to manage angioedema by avoiding exposure to triggers that include: Excessive heat, eating spicy foods, and alcohol consumption.

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated. […] The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] Once symptoms are adequately controlled, physicians should consider stepping down treatment sequentially.

• #1 Urticaria and Angioedema Treatment | IntechOpen

  https://www.intechopen.com/chapters/55133

  The international urticaria guidelines advise standard dose, second-generation H1-antihistamines as first-line therapy. […] The urticaria guideline recommends addon omalizumab, cyclosporin A (CsA) or montelukast third line in patients with an inadequate response to high-dose H1 antihistamines. […] In refractory patients, short courses of oral steroids may induce a remission in about 50% of cases. […] It is clear that the current evidence-based treatment algorithm does not fit every urticaria patient. […] The primary treatment option in long-term treatment of chronic urticaria is again second-generation nonsedative H1 antihistamines. […] If a patient’s CSU symptoms persist after 14 weeks of second-line treatment, addon omalizumab, CsA, or montelukast are recommended as third-line options.

• #1 Angioedema – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/skin-allergy/angioedema

  Antihistamines are commonly used to treat angioedema. […] The aim of treatment is to stop the episodes of angioedema from happening, make them less frequent or make the symptoms less severe. […] Most medications, such as antihistamines, used to treat angioedema are generally considered safe during pregnancy and while breastfeeding.

• #2 Urticaria and angioedema | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0288-z

  Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). […] The mainstay of management for angioedema is to avoid specific triggers, if possible. For hereditary angioedema, there are specifically licensed treatments that can be used for the management of acute attacks, or for prophylaxis in order to prevent attacks. […] Although the angioedema associated with these disorders is often self-limited, laryngeal involvement can lead to fatal asphyxiation. […] Short-term prophylaxis (STP) refers to the practice of treating patients to reduce the risk of associated and consequent morbidity and mortality during a period of time when there may be an increased risk of having an attack of angioedema. […] LTP should be considered in patients with HAE and AAE when their attack frequency and severity are not adequately controlled with acute therapy alone.

• #2 Acute urticaria: Causes, Features, and Treatment — DermNet

  https://dermnetnz.org/topics/acute-urticaria

  Acute urticaria can be induced by the following factors but the cause is not always identified. […] In addition to antihistamines, the cause of urticaria should be eliminated if known (eg drug or food allergy). Avoidance of relevant type 1 (IgE-mediated) allergens clears urticaria within 48 hours. […] In addition to antihistamines, the triggers for urticaria should be avoided where possible.

• #2 Hives (Urticaria) | Causes, Symptoms & Treatment

  https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/

  If the cause of hives can be identified, the best treatment is to avoid the trigger or eliminate it: Foods: Don’t eat foods that have been identified to cause your symptoms. […] Chronic hives should be evaluated by an allergist, who will ask about your and your family’s medical history, substances to which you are exposed at home and at work, exposure to pets or other animals and any medications you’ve taken recently. […] The best way to identify your symptoms is to talk to an allergist who can diagnose and treat both hives and angioedema.

• #2

  https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/allergy/urticaria_and_angioedema

  Urticaria and angioedema may be allergic or non-allergic (spontaneous). In spontaneous urticaria/angioedema there may be exacerbating factors (eg heat, cold, pressure, stress, some medications). […] Patients with troublesome symptoms (rash or swelling) despite high dose prophylaxis with non-sedating antihistamines (3-4x/day). […] Spontaneous urticaria and angioedema should be treated initially with non-sedating antihistamines. […] Treatment may be as required or prophylactic depending on symptom frequency of symptoms. […] Higher than licensed doses may be required (eg cetirizine 10mg or fexofenadine 180mg up to 4x/day). […] Long term regular corticosteroids are not advised. […] All patients with angioedema should avoid ACE inhibitors. […] Patients with urticaria and/or angioedema should be advised to use NSAIDS with caution.

• #2 Hives & Angioedema in Children | UH Rainbow Babies & Children’s Hospital | University Hospitals

  https://www.uhhospitals.org/rainbow/services/pediatric-allergy-and-immunology/conditions-and-treatments/hives-and-angioedema-in-children

  To lower your likelihood of experiencing hives or angioedema, take the following precautions: […] Avoid known triggers: If you know what triggers your hives, try to avoid that substance. […] Bathe and change your clothes: If pollen or animal contact has caused your hives in the past, take a bath or shower and change your clothes after exposure to pollen or animals.

• #2 Reddit – The heart of the internet

  https://www.reddit.com/r/urticaria/comments/176five/chronic_urticaria_angioedema_for_3_years_my_story/

  I’ve had chronic urticaria/angioedema for the last three years and 2 months ago to the day I woke up hive free for the first time. […] After 18 months taking cetrinizine with no effect, and after blowing a lot of money on consultants who were as stumped as me, I finally said screw it – this isn’t working. So I stopped all the anti-histamines and started researching myself. […] So I stopped drinking alcohol, and that helped but didn’t get rid of them. […] my research led me to the following as potentially having some effect on immune system and histamine response: Lions mane mushroom, Chaga mushroom, Cordyceps mushroom, Ashwagandha root, Rhodiola Rosea. […] Started taking them, and 2 weeks later I woke up urticaria free. 2 weeks after that and no more angioedema. […] Currently, I’m taking the supplements every day but 2/3 the dosage the bottles recommend, I’m still drinking the odd alcoholic drink, and still get the odd hive but I could count on one hand the amount I get. Angioedema completely gone and I’ve started the gym – squatting 60kg on my back with zero swelling after. […] I’m aware that this might be fluke or coincidence, and please this is not medical advice, but maybe someone out there can be inspired to keep going because there is light at the end of the tunnel.

• #2 Angioedema – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/skin-allergy/angioedema

  Angioedema is a condition where small blood vessels leak fluid into the tissues under the skin, causing swelling in different parts of the body. […] It is possible to develop angioedema without also developing hives. […] There is no known cure, but with the right diagnosis and management with appropriate medication, it can usually be prevented. […] Severe throat swelling requires the early use of medication (adrenaline for anaphylaxis or medication for HAE) followed by immediate transfer to hospital by ambulance. […] People with repeated angioedema should be referred by their doctor to a clinical immunology/allergy specialist for diagnosis and management. […] Avoid the triggers that make symptoms worse. It may be possible to manage angioedema by avoiding exposure to triggers that include: Excessive heat, eating spicy foods, and alcohol consumption.

• #2 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Second-generation H1 antihistamines are first-line medication for the treatment of acute urticaria. […] In severe cases, corticosteroids such as prednisone or prednisolone (0.5 to 1 mg per kg per day) may be added for three to 10 days to control symptoms. […] Treatment of acute angioedema is largely the same as treatment for urticaria, although corticosteroids may be more commonly recommended. […] Most of the data on treatment of urticaria involve chronic cases. […] Current guidelines suggest a stepwise approach to treating chronic idiopathic urticaria. […] If first-line treatment is insufficient, the second step is implementation of one or more of the following additional strategies: the second-generation H1 antihistamine can be titrated up to two to four times the usual dose; a different second-generation H1 antihistamine can be added; first-generation H1 antihistamines may be added at nighttime; H2 antihistamines may be added; and leukotriene receptor antagonists can also be added.

• #2 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated. […] The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] Once symptoms are adequately controlled, physicians should consider stepping down treatment sequentially.

• #2 Urticaria and Angioedema Treatment | IntechOpen

  https://www.intechopen.com/chapters/55133

  The international urticaria guidelines advise standard dose, second-generation H1-antihistamines as first-line therapy. […] The urticaria guideline recommends addon omalizumab, cyclosporin A (CsA) or montelukast third line in patients with an inadequate response to high-dose H1 antihistamines. […] In refractory patients, short courses of oral steroids may induce a remission in about 50% of cases. […] It is clear that the current evidence-based treatment algorithm does not fit every urticaria patient. […] The primary treatment option in long-term treatment of chronic urticaria is again second-generation nonsedative H1 antihistamines. […] If a patient’s CSU symptoms persist after 14 weeks of second-line treatment, addon omalizumab, CsA, or montelukast are recommended as third-line options.

• #2 Urticaria & Angioedema | Allergy Conditions | OneWelbeck

  https://onewelbeck.com/conditions/urticaria-and-angioedema/

  The aim of treatment is to suppress the symptoms until the condition resolves of its own accord, rather than curing it. […] Antihistamine tablets block the effects of histamine and should improve the itch and the rash in most people. They may not relieve urticaria completely. If urticaria occurs frequently, antihistamines should be taken regularly every day. The type, combination and dose of these drugs has to be tailored for each individual. […] The treatment of chronic urticarias includes the use of regular high dose antihistamines and additional medications such as montelukast. However, a significant number of patients will remain symptomatic and require additional treatments. […] Omalizumab monthly injections. Omalizumab (a recombinant, humanized anti-IgE antibody) is an add on therapy for the treatment of CSU in adults and adolescents with an inadequate response to treatment with antihistamines. […] Immunosuppressants e.g. ciclosporin medication.

• #2 Urticaria and Angioedema Treatment | IntechOpen

  https://www.intechopen.com/chapters/55133

  Omalizumab is currently the only agent licensed for the third-line treatment of CSU. […] C1INH replacement therapy maintains a central role for the treatment of angioedema attacks in patients with HAE. […] Fresh frozen plasma, C1 inhibitor, and icatibant appear to be safe and effective therapeutic options for the management of ACEI-induced angioedema.

• #2 Urticaria or Angioedema Clinical Pathway — Emergency Department and Primary Care | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/urticaria-angioedema-clinical-pathway

  If known hx of Hereditary Angioedema (HAE) follow action plan, consult immunology […] Consider additional cetirizine dose prior to discharge for persistent symptoms […] Consider additional cetirizine dose […] Consider referral to allergy.

• #2 Practical Management of New-Onset Urticaria and Angioedema Presenting in Primary Care, Urgent Care, and the Emergency Department

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8784078/

  All patients with chronic urticaria, daily hives lasting more than 6 weeks, should be referred to Allergy for long-term follow-up and to determine if an additional therapy such as omalizumab (anti-IgE) may be warranted. […] When angioedema presents without itching or hives, it is often bradykinin mediated. […] There is typically no effective treatment for a newly presenting case of angioedema, unless it has been confirmed to be from HAE or AAE, a complement system defect. […] Epinephrine, antihistamines, and systemic steroids do not help idiopathic or bradykinin-mediated angioedema and can have severe side-effects. […] The most useful treatment is watchful waiting, maintaining the airway, discontinuation of the implicated ACE inhibitor, and allowing normal homeostasis to return. […] There are now a variety of drugs approved for the prevention bradykinin-mediated angioedema, including C1-INH concentrates, the bradykinin B2-receptor antagonist, icatibant, and the kallikrein inhibitors, ecallantide, lanadelumab, and berotralstat, all of which are managed by the allergy department.

• #2 Angioedema – Wikipedia

  https://en.wikipedia.org/wiki/Angioedema

  In allergic angioedema, avoidance of the allergen and use of antihistamines may prevent future attacks. […] Future attacks of HAE can be prevented by the use of androgens such as danazol, oxandrolone or methyltestosterone. […] In 2018, the U.S. Food and Drug Administration approved lanadelumab, an injectable monoclonal antibody, to prevent attacks of HAE types I and II in people over age 12.

• #2 Urticaria & Angioedema | AMBOSS Rotation Prep

  https://resident360.amboss.com/pediatrics/pediatric-allergy-immunology/urticaria-angioedema/urticaria-angioedema.html

  Urticaria can be classified as acute or chronic, depending on the duration of symptoms: […] If a trigger is identifiable, avoidance is the first step. […] Omalizumab is a monoclonal antibody that targets IgE and is approved for use in chronic idiopathic urticaria refractory to high-dose antihistamines in patients aged 12 years and older. […] HAE prophylaxis options include the following: purified C1-inhibitor concentrate, available for prevention of attacks in an IV and subcutaneous preparation. […] Oral berotralstat (plasma kallikrein inhibitor); FDA approved in December 2020.

• #2

  https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/allergy/urticaria_and_angioedema

  No investigations are routinely indicated, and should only be performed if there is a specific indication. The exception is complement C4 levels in angioedema alone. […] ACE inhibitor treatment can cause angioedema (without urticaria) even after months or years of treatment and must be stopped in patients presenting with angioedema. […] Angioedema in the absence of urticaria also raises the possibility of hereditary/acquired angioedema; check complement C4 to exclude this.

• #2 Angioedema: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000846.htm

  Hives and angioedema may also occur after infections. Angioedema may occur alone or with other illnesses (including autoimmune disorders such as lupus, leukemia, and lymphoma). […] People with angioedema should: Avoid any known allergen or trigger that causes their symptoms. Avoid any medicines, herbs, or supplements that are not prescribed by a provider. […] If the person has trouble breathing, seek medical help right away. A severe, life-threatening airway blockage may occur if the throat swells.

• #2 Definition, classification and treatment of urticaria

  https://allerg.qc.ca/Information_allergique/4_3_urticaire_en.html

  Urticaria, commonly known as hives, is a skin condition marked by itchy, swollen patches of various sizes. […] When the swelling extends to deeper layers of the skin, it is called angioedema. Angioedema develops in up to half of those with hives. Both conditions can manifest simultaneously. […] Sometimes, it represents an actual allergic reaction caused by a food, a medication, an insect sting, or another sensitizing agent. […] If you suddenly develop hives or angioedema along with other symptoms such as trouble breathing, tightness in the throat, nausea or vomiting, cramping abdominal pain, or passing out, you should seek medical attention as soon as possible. […] Avoid factors that evoke the physical urticarias, such as excessive heat, the sun, tight clothing or irritants, etc. […] Avoid vasodilatory factors which may potentialize urticaria, such as alcohol, nicotinic acid, anti-inflammatories, several anti-hypertensive medications and diverse food „irritants” (such as acidic foods, spices, fermented foods and charcuterie). […] Treat, if possible, any disease that may cause the urticaria (secondary urticaria or angioedema).

• #2 Urticaria and Angioedema – Journal of Urgent Care Medicine

  https://www.jucm.com/urticaria-and-angioedema-2/

  The treatment of infection-related urticaria is treatment of the underlying infection; usually, the hive response abates in 48 to 72 hours. […] Urticaria is frequently the presenting sign, even before thyroid function is abnormal. […] This form of urticaria can be difficult to control, but maybe helped by treating hypothyroidism if present, and may spontaneously remit over months or years. […] Oral antihistamines should never be prescribed for prn use, since they are preventative by occupying the H1 histamine receptor. […] Similarly, oral corticosteroids are usually very effective for treating urticaria and angioedema, and their failure implies a complicated or severe form of the disease. […] It is appropriate for the urgent care provider to refer the patient on oral antihistamines or a short burst of corticosteroid back to their primary physician. […] If an allergic cause is strongly suspected, then referral to an allergist may be appropriate. […] It is very helpful to reassure them that much of the time a cause can be found and it is usually benign—and, more importantly, that the symptoms can be controlled.

• #2 Hives (Urticaria) | Causes, Symptoms & Treatment

  https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/

  Hives Management and Treatment: Avoid known triggers. See an allergist, who is specially trained to look for triggers to your hives and may recommend medications to prevent the hives or reduce the severity of symptoms. Whether your allergist suggests a treatment available only by prescription or an over the counter treatment will depend on several factors, including how uncomfortable the hives are making you. […] If your hives last more than a month or if they recur over time, see an allergist, who will take a history and perform a thorough physical exam to try and determine the cause of your symptoms. A skin test and challenge test may also be needed to identify triggers. […] Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives. They work by blocking the effect of histamine, a chemical in the skin that can cause allergy symptoms, including welts. Antihistamines that don’t make you drowsy are preferred.

• #2 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Urticaria is caused by immunoglobulin E- and nonimmunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. […] The mainstay of treatment is avoidance of triggers, if identified. […] Second-generation H1 antihistamines are safe and effective symptomatic therapy for urticaria. […] If needed to control symptoms of urticaria, second-generation H1 antihistamines can be titrated to two to four times the normal dose. […] A short course of systemic corticosteroids may help control severe cases of urticaria. […] The mainstay of treatment is avoidance of identified triggers. […] It is also recommended that patients avoid using aspirin, alcohol, and NSAIDs, as well as avoid wearing tight clothing, because these may worsen symptoms. […] If trigger avoidance is impossible, no trigger is identified, or symptom relief is needed despite trigger avoidance, H1-antihistamines are first-line pharmacotherapy.

• #2 Urticaria and angioedema | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-7-S1-S9

  Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). […] The management of HAE and AAE involves both prophylactic strategies to prevent attacks of angioedema (i.e., trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy) as well as pharmacological interventions for the treatment of acute attacks (i.e., C1 inhibitor replacement therapy, ecallantide and icatibant). […] Prophylactic therapy should be considered in patients who experience more than one severe attack per month, or if treatment for acute episodes is not sufficiently effective or is not available. Therapeutic options include: trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy.

• #2 Urticaria and Angioedema – Information for Parents and Carers | Hull University Teaching Hospitals NHS Trust

  https://www.hey.nhs.uk/patient-leaflet/urticaria-and-angioedema/

  The most commonly used medications for urticaria and angioedema are antihistamines. These can be used at the start of an attack to reduce the itching, rash and swelling. […] If the urticaria or angioedema occurs frequently then antihistamines are best taken every day to prevent attacks. For those with recurrent urticarial and angioedema antihistamines can be safely taken for prolonged periods of months or even years. […] If there is not any urticaria or angioedema for several weeks when taking antihistamines then it is worth stopping the medication to see if they are still needed. If the urticaria/angioedema returns, the antihistamine should be restarted.

• #3 Hives and Angioedema – Advanced Allergy & Asthma Family Care

  https://statenislandallergy.com/hives-and-angioedema/

  Hives and angioedema may be allergic and your allergist can perform testing to try and help identify a cause for your symptoms. […] Your doctor can also provide you with treatment for your hives to try and relieve the itching and control the swelling. […] Approximately half of the patients with chronic hives will respond to antihistamines. […] For those who do not respond, there is an FDA approved medication for the treatment of chronic idiopathic urticaria (CIU) known as omalizumab (Xolair). This medication is injected under the skin once a month and can often be life-changing for patients suffering from chronic hives.

• #3

  https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/allergy/urticaria_and_angioedema

  Urticaria and angioedema may be allergic or non-allergic (spontaneous). In spontaneous urticaria/angioedema there may be exacerbating factors (eg heat, cold, pressure, stress, some medications). […] Patients with troublesome symptoms (rash or swelling) despite high dose prophylaxis with non-sedating antihistamines (3-4x/day). […] Spontaneous urticaria and angioedema should be treated initially with non-sedating antihistamines. […] Treatment may be as required or prophylactic depending on symptom frequency of symptoms. […] Higher than licensed doses may be required (eg cetirizine 10mg or fexofenadine 180mg up to 4x/day). […] Long term regular corticosteroids are not advised. […] All patients with angioedema should avoid ACE inhibitors. […] Patients with urticaria and/or angioedema should be advised to use NSAIDS with caution.

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