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Checklist: Acute Urticaria and Chronic Urticaria

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice.         

For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

pdfASCIA HP Acute Urticaria Chronic Urticaria 202583.07 KB

The aim of checklist is to provide a summary of typical differences between acute urticaria (hives), which is a common, transient condition, and chronic spontaneous urticaria, to help guide management. It is important to differentiate between these conditions to determine the best approach to treatment.

Symptoms

Acute Urticaria (New Onset), <6 weeks of symptoms

Chronic Spontaneous Urticaria (CSU)

Pruritic wheals appear anywhere on the body

Yes:
Wheals usually resolve within 1-2 days, but can last up to 6 weeks.

Yes:
Wheals can be large and persistent, presenting on most days for 6 weeks or longer.

Severe symptoms that affect day to day function, leading to sleep disturbance, daytime tiredness, poor concentration.

Rarely:
Do not usually occur

Yes:
If uncontrolled

Triggers

Acute Urticaria

Chronic Spontaneous Urticaria (CSU)

Allergens, such as foods, drugs, insects, plants, pollens, dust mite, animal saliva.

Sometimes:
Relevant exposure is usually within 1-2 hours pre-rash

Rarely

Infections and post-infections

Yes:
Very common in children

Sometimes

Physical factors, such as heat, exercise, stress (cholinergic urticaria), cold temperatures (cold urticaria), alcohol and hormonal changes.

Yes

Yes

Non steroidal anti-inflammatory (NSAIDS) medications

Sometimes

No

Autoimmune conditions

Less common

Sometimes

Idiopathic (unknown)

Less common

Sometimes

Tests

Acute Urticaria

Chronic Spontaneous Urticaria (CSU)

Skin prick tests or blood tests for allergen specific IgE)

Not usually/rarely required:
Should only be performed if specific allergen/s are  suspected

Not recommended:
May be positive due to co-existent sensitisation or allergic disease

Other tests required for diagnosis

Not usually/rarely required:
Single episodes do not require testing

Sometimes:
Blood tests may be ordered if an underlying condition is suspected. Specialist tests can help determine medication responses.

Treatments and Referrals

Acute Urticaria

Chronic Spontaneous Urticaria (CSU)

Trigger avoidance or minimisation

Yes:
 If triggered by allergen/s or induced by irritant/s

Yes:
 It is useful to identify triggers so they can be minimised

Antihistamine tablets or syrups (non-sedating)

Yes:
To relieve itch and swelling

Yes:
Higher doses are usually required to relieve itch and swelling

Oral corticosteroids (short course)

No

Occasionally:
Short term use only

Biologics

No

Yes:
If severe, and/or lack of response to high dose antihistamines

Referral to clinical immunology /allergy specialist recommended

Not usually/rarely required:
Unless potential allergic trigger identified on history

Yes:
To assess triggers and for medical management

© ASCIA 2025

Content developed April 2025

For more information go to www.allergy.org.au/hp/skin (health professionals) or www.allergy.org.au/patients/skin-allergy (patients/carers)

To support allergy and immunology research go to www.allergyimmunology.org.au/donate 

Checklist: Non-Allergic Rhinitis, Allergic Rhinitis and Chronic Rhinosinusitis with Nasal Polyps

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice.         

For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

pdfASCIA HP Non-Allergic Rhinitis, Allergic Rhinitis and Chronic Rhinosinusitis 2025136.06 KB

The aim of checklist is to provide a summary of typical differences between non-allergic rhinitis (NAR), allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP), to help guide management of these conditions. It is important to note that some people have more than one of these conditions, and careful clinical assessment can help to determine the best approach or combination of treatments.

Symptoms

Non-Allergic Rhinitis

Allergic Rhinitis

Chronic Rhinosinusitis with Nasal Polyps

Nasal blockage or congestion, runny nose (rhinorrhoea), itchy nose, ears or throat, sneezing.

Yes

Yes

Yes: symptoms can be severe and persistent (lasting for > 12 weeks)

Loss of sense of smell (anosmia)

No

Variable

Yes

Itchy, watery, red eyes (allergic conjunctivitis)

No

Yes

No

Severe symptoms that affect day to day function, leading to sleep disturbance, daytime tiredness, poor concentration.

No

Yes:
if uncontrolled

Yes:
if uncontrolled

Recurrent sinus infections

No

Not usually

Yes

Triggers

Non-Allergic Rhinitis

Allergic Rhinitis

Chronic Rhinosinusitis with Nasal Polyps

Inhaled allergens, such as pollen, dust mite, moulds, animal dander.

No

Yes

Maybe

Irritants such as strong odours, perfumes, cleaning products, air-conditioning, smoke, fumes

Yes

Maybe

Maybe

Physical factors, hormonal factors, medications, overuse of nasal decongestants, older age and chronic health issues.

Yes

No

Maybe

Exercise provoked symptoms

Yes: vasomotor rhinitis

No

No

Tests

Non-Allergic Rhinitis

Allergic Rhinitis

Chronic Rhinosinusitis with Nasal Polyps

Allergy test results to inhaled allergens (skin tests or blood tests for allergen specific IgE)

Consider: negative results can rule out AR

Yes:
test results are usually positive

May be positive:
but do not cause  the condition

Other tests required for diagnosis

No

No

Consider:
Endoscopy or CT scans

Treatments and Referrals

Non-Allergic Rhinitis

Allergic Rhinitis

Chronic Rhinosinusitis with Nasal Polyps

Trigger avoidance or minimisation

Yes

Yes

Yes

Saline (salt) nasal sprays or rinses

Yes

Yes

Yes

Antihistamine tablets or syrups

No

Yes

Yes

Antihistamine nasal sprays

Yes

Yes

Yes

Decongestant tablets or nasal sprays

Short term use only:
3-5 days

Short term use only:
3-5 days

Short term use only:
3-5 days

Corticosteroid nasal sprays used regularly and correctly

Yes

Yes

Yes

Combined corticosteroid and antihistamine nasal sprays used regularly and correctly

Yes

Yes

Yes

Allergen Immunotherapy – this requires specific allergens to be confirmed (skin tests or blood tests for allergen specific IgE)

No

Yes:
if not responsive to other therapies

Consider

Antibiotics

No

No

Occasionally

Oral corticosteroids (short course)

No

No

Occasionally:
short term use only

Biologics

No

No

Yes:
if severe

Surgery

No

No

Consider:
refer to ENT surgeon

Referral to clinical immunology/allergy specialist recommended

Consider:
can help to confirm the right diagnosis

Yes:
if severe, and to consider allergen immunotherapy if not responsive to other therapies

Yes:
to assess allergens and for medical management

© ASCIA 2025

Content developed March 2025

For more information go to www.allergy.org.au/hp/allergic-rhinitis (health professionals) or  www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis (patients/carers)

To support allergy and immunology research go to www.allergyimmunology.org.au/donate 

ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans

ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans

ASCIA Action Plans for Anaphylaxis

ASCIA Action Plans for Anaphylaxis are emergency response plans for severe allergic reactions (anaphylaxis). Major updates were made in the 2023 versions, and only minor updates have been made to the 2025 versions. Prior versions (2023) will still be valid for use in 2025.

For further information about ASCIA Action Plans go to www.allergy.org.au/hp/anaphylaxis/action-plans-for-allergic-reactions-faq 

ASCIA Action Plan for Anaphylaxis (RED) 2025

  • ASCIA Action Plan for Anaphylaxis (RED) 2023
    ASCIA Action Plan for Anaphylaxis (RED) 2025

    for use with any brand adrenaline injectors 2025

  • ASCIA Action Plan for Anaphylaxis (RED)

    for use with any brand adrenaline device

    The general version of this plan is for people with allergies who have been prescribed either brand of adrenaline device.

    Device specific versions are available below.
    These plans are not for allergic rhinitis (hay fever) due to pollen, dust mite, animals or other inhaled allergens.

  • ASCIA Action Plan for Anaphylaxis (RED) Anapen® 2025
    ASCIA Action Plan for Anaphylaxis (RED) Anapen® 2023

    for use with adrenaline injectors 2023

  • ASCIA Action Plan for Anaphylaxis (RED) EpiPen® 2025
    ASCIA Action Plan for Anaphylaxis (RED) EpiPen®

    for use with EpiPen adrenaline autoinjectors

ASCIA Action Plan for Drug Allergy (GREEN)

  • ASCIA Action Plan for Drug (Medication) Allergy
    ASCIA Action Plan for Drug (Medication) Allergy (GREEN) 2025

    This plan is provided to people with drug (medication) allergies who are not usually prescribed an adrenaline device, because accidental exposure to drugs can mostly be avoided.  They are usually recommended to wear medical identification, to avoid exposure to drugs used in medical procedures. 

    pdfASCIA Action Plan for Drug Allergy (GREEN) 2025 

  • ASCIA Record for Drug (Medication) Allergy
    ASCIA Record for Drug (Medication) Allergy (GREEN) 2023

    This record should be used in conjunction with the patient’s ASCIA Action Plan for Drug (Medication) Allergy

    pdfASCIA Record Drug Allergy 2023 

ASCIA Action Plan for Allergic Reactions (GREEN)

  • ASCIA Action Plan for Allergic Reactions (GREEN)
    ASCIA Action Plan for Allergic Reactions (GREEN)

    no adrenaline autoinjectors 2021

  • ASCIA Action Plan for Allergic Reactions (GREEN)
    ASCIA Action Plan for Allergic Reactions (GREEN) 2025

    This plan is provided to people with allergies who have not been prescribed an adrenaline device. 

    This plan is not for allergic rhinitis (hay fever) due to pollen, dust mite, animals or other inhaled allergens.

ASCIA First Aid Plans for Anaphylaxis (ORANGE)

This plan can be used as a poster or stored with general use adrenaline devices.

A version of this plan for use by crew on aircraft is available upon request.

For translated versions of the ASCIA First Aid for Anaphylaxis go to www.allergy.org.au/hp/anaphylaxis#ta5

ASCIA Travel Plan for people at risk of anaphylaxis

  • ASCIA Travel Plan for people at risk of anaphylaxis 2023
  • ASCIA Travel Plan for people at risk of anaphylaxis 2023
    ASCIA Travel Plan for people at risk of anaphylaxis 2023

    This plan should be used with an ASCIA Action Plan for Anaphylaxis.

ASCIA Action Plan and Management Plan for Eczema

ASCIA Action Plan and Management Plan for Eosinophilic Oesophagitis (EoE)

ASCIA Action Plan for FPIES (food protein-induced enterocolitis syndrome) 

ASCIA Immunodeficency Plans 

ASCIA Management Plan for Hereditary Angioedema (HAE)

ASCIA Management Plan for Hereditary Angioedema

 ASCIA Treatment Plan for Allergic Rhinitis

ASCIA Treatment Plan for Allergic Rhinitis

 ASCIA Treatment Plans for Immunotherapy

Content updated August 2024

Read more …ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans

ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans

ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans

ASCIA Action Plans for Anaphylaxis (RED)

Current ASCIA Action Plans are the 2023 versions. However, prior versions (2022 and 2021) are still valid for use in 2023.  ASCIA Action Plans do not expire, and therefore the plan is still valid beyond the date of review, which is a guide for patients to see their doctor. For further information about ASCIA Action Plans go to www.allergy.org.au/hp/anaphylaxis/action-plans-for-allergic-reactions-faq 

ASCIA Action Plan for Anaphylaxis (RED) 2023
  • ASCIA Action Plan for Anaphylaxis (RED) 2023
    ASCIA Action Plan for Anaphylaxis (RED) 2023

    for use with any brand adrenaline injectors 2023

  • ASCIA Action Plan for Anaphylaxis (RED)

    for use with any brand adrenaline injectors 2023

    The general version of this plan is for people with allergies who have been prescribed either brand of adrenaline injector devices.
    Device specific versions are available below.
    These plans are not for allergic rhinitis (hay fever) due to pollen, dust mite, animals or other inhaled allergens.

  • ASCIA Action Plan for Anaphylaxis (RED) Anapen® 2023
    ASCIA Action Plan for Anaphylaxis (RED) Anapen® 2023

    for use with adrenaline injectors 2023

  • ASCIA Action Plan for Anaphylaxis (RED) EpiPen® 2023
    ASCIA Action Plan for Anaphylaxis (RED) EpiPen®

    for use with EpiPen adrenaline autoinjectors

ASCIA Action Plan for Drug Allergy (GREEN)

  • ASCIA Action Plan for Drug (Medication) Allergy
    ASCIA Action Plan for Drug (Medication) Allergy (GREEN) 2023

    This plan is provided to people with drug (medication) allergies who are not usually prescribed an adrenaline injector, because accidental exposure to drugs can mostly be avoided.  They are usually recommended to wear medical identification, to avoid exposure to drugs used in medical procedures. 

    pdfASCIA Action Plan for Drug Allergy (GREEN) 2023 

  • ASCIA Record for Drug (Medication) Allergy
    ASCIA Record for Drug (Medication) Allergy (GREEN) 2023

    This record should be used in conjunction with the patient’s ASCIA Action Plan for Drug (Medication) Allergy

    pdfASCIA Record Drug Allergy 2023 

ASCIA Action Plan for Allergic Reactions (GREEN)

  • ASCIA Action Plan for Allergic Reactions (GREEN)

    no adrenaline autoinjectors 2021

  • ASCIA Action Plan for Allergic Reactions (GREEN)
    ASCIA Action Plan for Allergic Reactions (GREEN) 2023

    This plan is provided to people with allergies who have not been prescribed an adrenaline injector. 

    This plan is not for allergic rhinitis (hay fever) due to pollen, dust mite, animals or other inhaled allergens.

ASCIA First Aid Plans for Anaphylaxis (ORANGE)

This plan can be used as a poster or stored with general use adrenaline injectors.

A version of this plan for use by crew on aircraft is available upon request.

For translated versions of the ASCIA First Aid for Anaphylaxis go to www.allergy.org.au/hp/anaphylaxis#ta5

  • ASCIA First Aid Plan for Anaphylaxis (ORANGE)

  • ASCIA First Aid Plan for Anaphylaxis (ORANGE)

    for use with EpiPen adrenaline autoinjectors 2021

    ASCIA First Aid Plan for Anaphylaxis (ORANGE) 2023

    The general version of this plan can be used as a poster or stored with either brand of general use adrenaline injector devices. 

    Device specific versions are available below.

  • ASCIA First Aid Plan for Anaphylaxis (ORANGE) Anapen

  • ASCIA First Aid Plan Anaphylaxis (ORANGE) EpiPen 2023

  • ASCIA First Aid Plan for Anaphylaxis (ORANGE)

    for use with general adrenaline injectors 2023

  • ASCIA First Aid Plan for Anaphylaxis (ORANGE)

    for use with generic adrenaline autoinjectors 2021

    ASCIA First Aid Plan for Anaphylaxis (ORANGE) 2023 Pictorial Poster

    This plan can be used as a poster or stored with general use adrenaline injectors. 

ASCIA Travel Plan for people at risk of anaphylaxis

  • ASCIA Travel Plan for people at risk of anaphylaxis 2023
  • ASCIA Travel Plan for people at risk of anaphylaxis 2023
    ASCIA Travel Plan for people at risk of anaphylaxis 2023

    This plan should be used with an ASCIA Action Plan for Anaphylaxis.

ASCIA Action Plan and Management Plan for Eczema

ASCIA Action Plan and Management Plan for Eosinophilic Oesophagitis (EoE)

ASCIA Action Plan for FPIES (food protein-induced enterocolitis syndrome) 

ASCIA Immunodeficency Plans 

ASCIA Management Plan for Hereditary Angioedema (HAE)

ASCIA Management Plan for Hereditary Angioedema

 ASCIA Treatment Plan for Allergic Rhinitis

ASCIA Treatment Plan for Allergic Rhinitis

 ASCIA Treatment Plans for Immunotherapy

Content updated August 2024

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Food – Other Adverse Reactions

ASCIA other food reactionsOther adverse reactions to foods include eosinophilic oesophagitis (EoE), food protein-induced enterocolitis syndrome (FPIES), food protein induced allergic proctocolitis (FPIAP), food protein enterocolitis (FPE), oral allergy (food pollen) syndrome and food intolerances.

Food intolerance is a term that is used for a wide range of adverse reactions to foods that cause symptoms such as stomach pain, bloating, gas/flatulence, diarrhoea, irritable bowel syndrome (IBS), rashes, hives (urticaria), recurrent mouth ulcers or headaches. Food intolerances are sometimes confused with, or mislabeled as food allergies, but they involve the digestive system, whilst food allergies involve the immune system. Unlike food allergy, food intolerances (except for sulphite and benzoate reactions) do not cause anaphylaxis (severe allergic reactions), that can be life threatening.

Health Professional Information
Eosinophilic Oesophagitis (EoE)

EoE Action Plan 

EoE Management Plan   

EoE Dietary Guide - 2FED

EoE Dietary Guide - 4FED

Food Protein-Induced Enterocolitis Syndrome (FPIES)

FPIES Action Plan 

FPIES FAQ - including FPIES Dietary Guide

Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein Enterocolitis (FPE)

Management Plan for the Delayed Reactions to Food

Further Information
 

Webpage updated April 2025

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