Diagnosis and treatment of urticaria in primary care

Urticaria, also known as hives among people, is a very common disease characterized by erythematous, edematous, itchy, and transient plaques that involve skin and mucous membranes. It is classified as acute spontaneous urticaria, chronic spontaneous urticaria, chronic inducible urticaria, and episodic chronic urticaria. Many factors such as infections, medicines, food, psychogenic factors, and respiratory allergens are accused of etiology, but sometimes, it is idiopathic. Clinical presentation involves red, swelling, and itchy plaques. The lesions usually resolve spontaneously within 2–3 h without a trace. The patients are sometimes confronted with an angioedema that can also involve the respiratory tract. In this case mucous membranes, such as eyelids, lips, swell with some pain and burning sensation. If respiratory tracts are involved, it may be life threatening and should be treated urgently. The diagnosis is usually straightforward, urticarial vasculitis, drug eruptions, viral eruptions, and urticaria pigmentosa must also be considered. H1 antihistamines and, sometimes, short-term systemic corticosteroids are preferred for the treatment; H2 antagonists may be added during resistant cases, although other treatment options, such as omalizumab, cyclosporine, and leukotriene receptor antagonists, may be considered during missed events.