- Food allergies such as allergies to nuts, strawberries, citrus fruit, egg, food additives, spices, chocolate, or shellfish. Sometimes you can develop an allergy to a food even if you have eaten it without any problem many times before.
- Allergies to insect bites and stings.
- Allergies to medicines such as penicillin, aspirin, anti-inflammatory painkillers, etc.
- Viral infection such as a cold or 'flu can trigger an urticarial rash in some people. A mild viral infection which causes few other symptoms is probably a common trigger of an urticarial rash that develops without an apparent cause.
- Skin contact with 'sensitizers' causes a local area of urticaria in some people. For example, chemicals, latex, cosmetics, plants, ointments, nettle stings, etc.
- Physical urticaria. This is when a localized rash appears when the skin is physically stimulated. The most common is called dermographism when a rash develops over areas of skin, which are firmly stroked. Sometimes an urticarial rash is caused by heat, cold, emotion, exercise, or strong sunlight. See separate leaflet called 'Physical Urticaria'.
- Most people with acute urticaria do not feel 'ill', but the appearance of the rash and the itch can be troublesome.
- In some cases a condition called angioedema develops at the same time as urticaria. In this condition some fluid also leaks into deeper tissues under the skin which causes the tissues to swell.
- The swelling of angioedema can occur anywhere in the body but most commonly affects the eyelids, lips and genitals.
- Sometimes the tongue and throat are affected and become swollen. The swelling sometimes becomes bad enough to cause difficulty breathing.
- Symptoms of angioedema tend to last longer than urticarial weals. It may take up to three days for the swollen areas to subside and go.
- A variation called 'vasculitic urticaria' occurs in a small number of cases. In this condition the weals last more than 24 hours, they are often painful, may become dark red, and may leave a red pigmented mark on the skin when the weal goes.
- A blood test to find out whether the patient is suffering from anemia.
- A stool sample to check for parasites.
- ESR (erythrocyte sedimentation rate) test - this can identify problems with the patient's immune system.
- Thyroid function test - this identifies either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).
- Liver function tests - these can identify whether the patient has any liver problems.
- If a trigger can be identified, avoidance is the most effective form of management. This would include any food, medication, physical agent, or other factor that triggers the urticaria
- A cool bath or shower may ease the itch.
- Antihistamine tablets can ease symptoms. Antihistamines block the action of histamine which is involved in causing urticaria. You can get antihistamines on prescription.
- A short course of steroid tablets is sometimes prescribed in severe cases to help reduce swelling in the skin.
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