History:

Urticaria and angioedema are common cutaneous vascular reactions, 15 to 20% of  the population experience this problem during their life times. Urticaria is characterized by transient, pruritic, edematous, lightly erythematous papules or wheals, frequently with central clearing and may be caused by numerous factors, both immunologic and nonimmunologic, that result is vasodilation and transudation of fluid from small cutaneous blood vessels. The wheals are often circular or annular but may on occasion develop bizarre, figurate patterns. Individual urticarial lesions are transient, lasting 12 to 24 hours or less and in most cases less than 4 hours. Crops of hives may appear suddenly and resolve completely in a matter of hours, or new lesions may continue to appear almost indefinately. Most cases of urticaria are acute in duration, persisting only a few days to a few weeks. The etiology of acute urticaria is usually detectable. When urticaria persists longer than 6-12 weeks, it is considered chronic in nature. The cause is not found in 75 to 90% of these cases, and therefore treatment programes for chronic urticaria focus on measures that provide symptomatic relief. The intial aspect of therapy is the elimination of any suspected cause such a drug or food. In severe urticarial reactions or cases associated with asthma, laryngeal edema, or the threat of circulatory collapse, more aggressive medical management is required, which might include subcutaneous injection of epinephrine, systemic corticosteroids, or even hospitalization for possible airway intubation.

A 69-year-old female with chief complaint of edematous lesion on the lower lip and crops of urticarial lesions on the upper abdomen with negative history for any provacative factors. The complaint started one week ago. Vital signs showed an normal blood pressure and higher pulse rate than normal and other anaphylactic signs were not apparent. Patient was treated with diet restriction, antihistamines and low-dose corticosteroids. In this case there was no need for epinephrine injection and the patient was only an inpatient for one day under observation before discharge.