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Complications of chronic urticaria can include insomnia, depression and poorer quality of life.

Anaphylaxis may occur in association with acute urticaria.

A detailed history may point to a trigger in some cases.

In chronic or recurring cases where investigations are needed, these will be guided by history.

An additional sedating antihistamine such as chlorphenamine may be useful if itch is interfering with sleep.

Avoid hydroxyzine if the person has a prolonged QT interval or risk factors for QT interval prolongation in line with recent guidance from the Medicines and Healthcare products Regulatory Agency (MHRA).

Acute urticaria is most common in children and is more common in women than in men, particularly in the 30-60 age range. Urticaria is due to activation of mast cells in the skin, resulting in the release of histamine and other mediators.

Where symptoms are severe, a short course of oral steroids may be appropriate - for example, prednisolone 40 mg daily for seven days.

Acute urticaria is much more common than chronic urticaria.

(Estimated lifetime incidence is 1 in 6 people compared to 1 in 1,000.) The prevalence rate for chronic urticaria has been estimated as 1-5 per 1,000.

Urticarial vasculitis is vasculitis of the skin characterised by inflammation of the small blood vessels rather than urticaria.

Causes include infection (hepatitis B/C, glandular fever or streptococcal infection), medication (penicillins, fluoxetine, thiazides, allopurinol, quinolones or carbamazepine), autoimmune disease, paraproteinaemia and malignancy.