Cases: Feb 08
  A 58-year old business man presents with a 2 day history of intensely itchy generalised rash and slightly swollen lips. No present history of infection or past dermatological problems.
What's the diagnosis and what treatment would you suggest?
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See the answer
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Presence of itchy wealing showing fluctuation activity concomittant with mucosa involvement is diagnostic for acute urticaria and angioedema. In contrast to chronic urticaria exogenous causes are often most likely. Thus, food- or drug allergy, or insect sting must be suspected. Likewise, non-allergic histamine release provoked by salicylates or azo dyes, or infections such as hepatitis, sinusitis are factors to be considered. Chronic urticaria lasts for more than 6 weeks and is often autoimmune in origin.
Discontinuation of suspected drug. Treatment with antihistamines (loratidine 10mg, cetirizine 10mg or fexofenadine 180mg) may be effective, but sometimes a short course of oral steroids may be needed.
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