Hives

HISTORY:

‍Itchy skin rash for ‍ ‍hoursdays

Location: ‍faceneckarmhandlegfootthoraxabdomenflankback, ‍migrating, ‍changing in size

Onset: ‍gradualsudden, following ‍

Pattern: ‍constantintermittent

‍red welts

‍itching

‍swelling

‍burning

‍fever, up to ‍°, over ‍ ‍hoursdays

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍runny nose, ‍clearcolored

‍swelling in the throat or mouth

‍shortness of breath

‍wheezing

‍dizziness

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash



ASSESSMENT:

‍Urticaria ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍IgE

- Allergy testing

- Skin biopsy if chronic

- ‍Antihistamines

- ‍H2 blockers

- ‍Steroids

- ‍Epinephrine

- Avoidance of known triggers

- Cool compresses

- Loose clothing

- Referral to allergist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as difficulty breathing, swelling of the lips or tongue, or dizziness

- Go to ER if severe allergic reaction occurs