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Acute urticaria

Definition
Acute urticaria is a self-limited cutaneous condition characterized by transient, erythematous, and pruritic wheals or hives.
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Pathophysiology
Acute urticaria is caused by mast cell and basophil activation, leading to the release of histamine and other inflammatory mediators, which results in vasodilation and increased vascular permeability, leading to characteristic skin lesions. The activation of these cells can occur through multiple triggers, including IgE- and non-IgE-mediated mechanisms.
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Epidemiology
The prevalence of acute urticaria in the United Kingdom is estimated at 355 per 100,000 population.
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Disease course
Clinically, acute urticaria presents as itchy, raised welts that can appear anywhere on the body. These hives are transient, often moving from one area of the body to another. In some cases, acute urticarial lesions may display central clearing with an ecchymotic or hemorrhagic hue.
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Prognosis and risk of recurrence
The prognosis of acute urticaria is generally good, as it is typically a self-limiting condition that resolves within 6 weeks.
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Key sources
The following summarized guidelines for the evaluation and management of acute urticaria are prepared by our editorial team based on guidelines from the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI/GA²LEN/EDF/EAACI 2022), the Australasian College of Dermatologists (ACD 2021), the American Academy of Family Physicians (AAFP 2017), and the American Academy of Allergy, Asthma & Immunology (AAAAI/ACAAI 2014).
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Guidelines

1.Screening and diagnosis

Pathophysiology
Recognize that acute urticaria and angioedema are often but not always related to mast cell and basophil activation from multiple triggers, which include IgE- and non-IgE-mediated mechanisms.
B
Recognize that acute urticaria and angioedema are more frequently associated with identifiable conditions.
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  • Differential diagnosis

2.Classification and risk stratification

Classification: classify urticaria based on its duration: acute (≤ 6 weeks) or chronic (> 6 weeks).
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3.Diagnostic investigations

Initial evaluation: as per EAACI 2022 guidelines, do not obtain any routine diagnostic evaluation in patients with acute spontaneous urticaria.
D

4.Diagnostic procedures

Skin biopsy: consider performing skin biopsy in rare circumstances to differentiate acute urticaria and angioedema from other inflammatory disorders.
C

5.Medical management

Antihistamines: as per AAFP 2017 guidelines, administer second-generation H1RAs as first-line symptomatic therapy for urticaria.
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  • Corticosteroids

  • Leukotriene antagonists

  • Epinephrine autoinjectors

6.Nonpharmacologic interventions

Avoidance of causative agents: elicit a detailed history of common causes of acute urticaria and angioedema, including medications and foods, and instruct on proper elimination if identified.
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