Urticaria and Angioedema

Although acute urticaria and angioedema are common in children, they are usually self-limited and cause only transient discomfort. However, when chronic, they can significantly affect quality of life and can be life threatening if the airway is affected. The causes of urticaria and angioedema are many, and a thorough medical history is the most important diagnostic tool. Nevertheless, the cause often remains idiopathic. Both immunoglobulin E– and non-immunoglobulin E–mediated immunologic mechanisms may be involved. Many nonallergic medical conditions, including various infections, autoimmune diseases, and malignancies, may present with urticaria and angioedema, sometimes before other manifestations of the disease become evident. The possibility of an underlying systemic disease should be considered in patients with chronic or atypical symptoms. Treatment involves identification and avoidance of the trigger if possible and chronic suppressive therapy if the cause cannot be identified or eliminated. Patients at risk for airway involvement should receive additional education and a supply of autoinjectable epinephrine.