Urticaria and Angioedema A Cased-based Discussion Urgent message: Patients often present to urgent care with symptoms associated with urticaria and angioedema. Identifying the probable cause can provide relief of symptoms and abate patient concerns. Kent A. Knauer, MD, Director, Allergy and Asthma Center, University Hospitals, Cleveland, OH 10 © Phototake USA (illustration, Jane Hurd; photograph, ISM) U rticaria and angioedema are rarely life threatening, but they are extremely disruptive to quality of life and sleep. In addition, hives may be alarming and lead patients to wonder if something serious is afoot. Swelling of the tongue or throat is particularly likely to be the source of some concern. Small wonder, then, that patients with acute urticaria and angioedema are often first evaluat- ed in an urgent care center. In this article, we will discuss urticaria and angioedema from my perspective as director of the Allergy and Asthma Center at University Hospitals in Cleveland, OH and as presented in three distinct patients who were treated in an urgent care set- ting. I will also offer some perspective on when to refer to a specialist and will provide a few illustrative cases along the way. Patients can adapt to many symptoms (including even moderate pain), but pruritis is not among them. Scratching is a response built into the nervous system; it cannot be denied and should be taken seriously. The goals of management are to identify the likely cause(s), and to eliminate the urticaria or, when that is not possible, to alleviate the symptoms. It may not be practical or even necessary to make a definitive diagnosis in the urgent care setting, but you should be able to make a reasonable educated guess and create a treatment plan. In most cases, the goal for urgent care is to initiate treatment and prescribe sufficient medications to get the person to their primary physician. It is when patients return to urgent care because of treatment failure and are still uncomfortable that diagnostic testing is indicated. There are five provable etiologies of urticaria includ- ing allergy, infection, autoimmune processes, medication induced, and physical forms of urticaria. Most cases of idiopathic urticaria are probably autoimmune in nature. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 6 w w w. j u c m . c o m