Urticaria or Angioedema Clinical Pathway, Emergency Department and Primary Care – Urticaria +/- Angioedema

Urticaria or Angioedema Clinical Pathway — Emergency Department and Primary Care

Urticaria

  • Urticaria is erythematous, blanching lesions often with central clearing
  • Individual lesions are transient and often lasting < 24 hrs, with associated pruritus
Urticaria on the stomach Urticaria on the face
Urticaria on the chest Urticaria on the back

Angioedema

Angioedema is non-pitting edema of deep layers of the skin that commonly occurs in the eyelids, mouth or genitals.

Angioedema Category Features
Histamine Mediated
More common
  • Often associated with allergic trigger (contact or ingested)
  • Typically rapid onset if associated with a trigger
  • Often associated with itching
  • Often associated with urticaria
  • Responsive to antihistamines
Bradykinin Mediated
  • Slower onset
    • Usually over 24 hr period
  • Progressive
  • Associated with erythemia marginatum – Polycylic and evanescent annular lesions
  • Usually associated with burning/tingling, rather than itching
  • Can be associated with ACE inhibitors
  • More likely to be associated with severe abdominal pain
  • Improves over 1–3 days
  • Usually unresponsive to antihistamines and epinephrine