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This guideline refers to children under 18 who may require further investigation and management of urticaria, angioedema or mastocytosis.
Chronic Urticaria occurs in 3% children, and acute urticaria occurs in 4.5-15% children.
Angioedema is much rarer occurring in 1/5000 patients.
Urticaria alone occurs in 50% of patients, angioedema with urticaria in 40% patients and angioedema alone in 10%.
The true incidence of mastocytosis is unknown
Anaphylaxis – see alternative referral pathway
History and examination of the child suggestive of urticaria or angioedema:
Urticaria is characterised by fluctuating weals and/or angio-oedema. A weal consists of three typical features:
Angio-oedema is characterised by:
The history must rule any possible triggers such as food (see food guideline), latex, stings, and drugs.
Please ensure you check for infections:
Consider physical causes
Check the drug history including NSAIDs and opiates.
Consider underlying vasculitic process
Airway compromise with angioedema +/- urticaria
Rubbing freckles or macules causes an urticated lesion
Baseline investigations can include
A non-sedating antihistamine should be started (syrup or tablet, as per BNFc doses)
Chapter 13 - Skin
If this is insufficient to control the symptoms after a month the dose can be doubled.
The BSACI management of chronic urticaria and angioedema algorithm may be helpful.
Please refer in to the paediatric allergy clinic if:
This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.
Publication date: 6 July 2016