Centre of Evidence of Dermatology Best practice guidelines

Guidelines chronic spontaneous urticaria Updated on december 2019


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Chronic spontaneous urticaria with angioedema presenting at emergency services

Back to decision-making tree Print last updated on 18/09/2020

Patient picture


Previous treatments

She usually takes desloratadine at a conventional dose (1 tablet per day), which she regularly forgets because her CSU causes her little discomfort.

Other elements

What do you suggest?

See proposition




  • Reassure the patient: the condition is not life-threatening, as it is not an acute allergic urticaria (IgE-mediated). The time between the occurrence of angioedema and the intake of medication or food is long; there are no signs of severity or associated visceral involvement, and the feeling of dyspnoea is likely due to anxiety caused by the angioedema. It is also not a bradykinin angioedema, as rapid spontaneous regression and the coexistence of superficial plaques do not support this diagnosis.
  • Explain that the flare-up is likely due to the aggravating factor of taking a non-steroidal anti-inflammatory drug and an opioid.
  • No complementary investigation is necessary.


  • The treatment is based on the increase of anti-H1 antihistamines: 4 anti-H1 tablets per os to be continued until improvement. It is not necessary to administer corticosteroids or adrenaline in this patient. There is no reason to hospitalise her.
  • Finally, explain to Mrs F. which medication to avoid in order to limit flare-ups, and how to intensify the treatment with anti-H1 antihistamines in the event of a flare-up.

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