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.

ASCIA 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