Managing acute urticaria.

The physician should be familiar with preventive measures for acute urticaria or its most severe form, anaphylaxis, and with the general principles of management. Treatment does not differ basically whether given in a nonmedical setting, the emergency room, or the office, except for the availability of special supplies and equipment, such as oxygen, if needed. In all cases, a history should be obtained quickly, the patient should be examined to confirm the diagnosis, and epinephrine should be administered. Hospitalization is indicated in severe cases with systemic symptoms. Once the acute episode has been treated, the physician must decide whether further investigation is necessary. Quite often a presumptive etiologic diagnosis is made on the basis of the history. Allergy testing is not part of the routine evaluation of the patient with urticaria.