Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
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  2. Urgent care
  3. Wounds, burns & skin
  4. Urticaria & allergic reactions
● Urgent care clinic · 30-minute consult

Urticaria & allergic reactions

Hives without airway or circulation problems — and when it’s anaphylaxis.

Typical consult⏱ 15 min
Investigations🔬 Usually none
Usual outcome💊 Non-sedating antihistamine ± short steroid
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
If you find……then
Airway, breathing or circulation problemAnaphylaxis — IM adrenaline 500 micrograms now
Angioedema of tongue / throat, hoarseness, stridorAirway — ED / anaesthetics
On an ACE inhibitor with angioedema (no hives)ACEi angioedema — doesn’t respond to adrenaline as well; stop ACEi, ED
Hives with fever, joint pain, bruising, lasting > 48 h in one spotUrticarial vasculitis / systemic illness
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
InvestigationOnly if…
None for acute urticariaTests rarely help; refer if recurrent / chronic (> 6 weeks)
5Treat & send home

Management & advice

  • Avoid the trigger if identified; stop suspected drugs
  • Cool showers, loose clothing
  • If anaphylaxis occurred: observe per RCUK, allergy referral, 2 adrenaline auto-injectors

Refer / follow-up

  • Anaphylaxis or severe angioedema → ED then allergy clinic
  • Chronic urticaria > 6 weeks → GP / dermatology
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
DrugDoseDuration / notes
Cetirizine (or loratadine)10 mg once a dayUntil symptoms settle (up to 6 weeks)
Fexofenadine (alternative)180 mg once a dayAs above
Prednisolone (severe acute urticaria only)40 mg once a dayUp to 7 days
6Safety-net
Say it like this

This is hives, an allergic-type rash. It isn’t dangerous on its own, and the antihistamine once a day should control it. It can come and go for a few days. If your lips, tongue or throat swell, you find it hard to breathe or swallow, or you feel faint, call 999 straight away.

Come back / call 111 — or 999 if severe — if:

  • Swelling of the lips, tongue or throat, difficulty breathing or swallowing, feeling faint — call 999
  • Rash with fever or feeling very unwell
  • Not settling after 2 weeks
7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Hivesnhs.uk/conditions/hives
8Document

Urticaria & allergic reactions — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — URTICARIA & ALLERGIC REACTIONS PRESENTING COMPLAINT: HISTORY Onset, trigger (food, drug, sting, infection, exercise): Swelling of lips/tongue, breathing, dizziness: New medicines (NSAIDs, antibiotics, ACE inhibitors): Previous episodes, atopy: RED FLAGS (record present / absent) [ ] Airway, breathing or circulation problem [ ] Angioedema of tongue / throat, hoarseness, stridor [ ] On an ACE inhibitor with angioedema (no hives) [ ] Hives with fever, joint pain, bruising, lasting > 48 h in one spot PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Obs incl. BP and sats: Airway: voice, stridor, tongue/uvula swelling: Wheals: transient, blanching, itchy; angioedema: INVESTIGATIONS: none required / None for acute urticaria — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Hives Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Swelling of the lips, tongue or throat, difficulty breathing or swallowing, feeling faint — call 999 - Rash with fever or feeling very unwell - Not settling after 2 weeks Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More wounds, burns & skin

Lacerations & wound careClose it right, check tetanus, and know which wounds aren’t yours.Minor burns & scaldsCool, cover, size it — and know when it goes to the burns unit.Human & animal bitesWho gets prophylaxis, rabies risk and the fight bite.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.