Guideline of the month - management of chronic urticaria and angioedema

The guideline

Guidance from the British Society for Allergy and Clinical Immunology (BSACI) aimed at healthcare professionals involved in the management of patients with chronic urticaria and angioedema.

Key points for GPs

• The diagnosis of chronic urticaria and angioedema should be based primarily on the clinical history, rather than allergy testing, including frequency and circumstances of onset, and triggers.

• Management must include the identification or exclusion of possible triggers, patient education and a personalised management plan.

• Food allergy can usually be excluded as a cause of urticaria/angioedema if there is no temporal relationship to a particular food trigger through either ingestion or contact.

• Autoimmune urticaria/angioedema in older children and adults may be associated with other autoimmune conditions, such as thyroiditis.

• ACE inhibitors can cause angioedema without weals, resulting in airway compromise. They are contraindicated in individuals with a history of angioedema with or without weals.

Practical issues

The contraindication of ACE inhibitors in patients with a history of angioedema could present problems if they also suffer from heart failure or hypertension, where the drugs are frequently used as part of treatment.

Expert comment

Dr Matt Doyle, a GP in Jersey, Channel Islands, and chair of the BSACI primary care group, said: ‘Chronic urticaria is a common presentation to primary care, usually accompanied by the question ‘what am I allergic to?’ But while food allergy may be a cause in children, in adults it becomes far less likely.

‘The guideline is helpful in diagnosis and management. It reads more like a review article than a guideline and details mechanisms, important questions in the history, and tests that could be done in primary care to identify the underlying cause. Importantly, it doesn’t rely on specialist allergy testing, but rather emphasises the opposite.’