Hives

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍itchy skin rash

Location is on ‍faceneckarmhandlegfootthoraxabdomenflankback, ‍migrating, ‍changing in size

Onset was ‍gradualsudden, ‍spontaneouswhileafter ‍

Pattern ‍persistentintermittent

Symptoms include:

‍red welts

‍itching

‍swelling

‍burning

‍fever, up to ‍°, over ‍ ‍hoursdays

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍runny nose, ‍clearcolored

‍swelling in the throat or mouth

‍shortness of breath

‍wheezing

‍dizziness



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍known allergies

‍recent exposure to allergens

‍recent viral infection

‍stress

no history of: ‍hives, ‍allergies, ‍asthma, ‍eczema

no use of: ‍antihistamines, ‍corticosteroids, ‍epinephrine auto-injector





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Urticaria ‍likelysuspectedpossible

DDx: urticaria, angioedema, anaphylaxis, drug eruption, atopic dermatitis, contact dermatitis, insect bites, viral rash, mastocytosis, urticarial vasculitis, serum sickness-like reaction, hereditary angioedema, exercise-induced urticaria, food allergy, pressure urticaria, cold urticaria, solar urticaria, heat urticaria, aquagenic urticaria, chronic idiopathic urticaria, contact urticaria syndrome, dermographism





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍IgE

- Allergy testing

- Skin biopsy if chronic

Treatments:

- ‍Antihistamines

- ‍H2 blockers

- ‍Steroids

- ‍Epinephrine

- Avoidance of known triggers

- Cool compresses

- Loose clothing

Further care:

- 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