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Urticaria – Information for GPs

Referral criteria / commissioning position

Refer to Dermatology if:

  • diagnostic uncertainty
  • chronic urticaria failing to respond to conventional primary care management
  • urticarial vasculitis
  • some patients with difficult to manage physical urticarias e.g. solar, cold

Immediate treatment with adrenaline and transfer to hospital if anaphylaxis.

Red flag symptoms

  1. Symptoms of anaphylaxis and severe angioedema
  2. If individual lesions last more than 24 hours consider alternative diagnosis:
  • Erythema multiforme
  • Urticarial vasculitis
  • Erysipelas
  • If female of child-bearing age polymorphic eruption of pregnancy
  • Connective tissue disease

Investigations prior to referral

In most cases of urticaria no investigations are necessary but these may be helpful in some cases:

  • blood tests for allergy
  • IgE level in acute or contact urticaria
  • FBC and ESR if urticarial vasculitis suspected
  • check TFT and antibodies in chronic urticaria – increased risk autoimmune thyroid disease with some types of chronic urticaria
  • H pylori status – check if recalcitrant urticaria and dyspepsia. Treatment may improve urticarial
  • physical challenge if physical urticaria suspected

Information to include in referral letter

  • How long symptoms have been present
  • What treatments have been tried in primary care and response to these
  • Any triggers identified
  • Treatments and interventions tried including the results
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient information leaflets

References

An excellent series of webpages covering the different types of urticaria and their management

http://www.pcds.org.uk/clinical-guidance/urticaria-and-angioedema

Other useful overviews from dermnet and patient.co.uk

http://www.dermnetnz.org/reactions/urticaria.html

http://www.patient.co.uk/doctor/Urticaria.htm

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