Urticaria or Angioedema Clinical Pathway — Emergency Department and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Related Pathway
- Anaphylaxis, ED

Anaphylaxis Pathway as indicated
Angioedema with airway involvement
- Administer IM Epinephrine
If known hx of Hereditary Angioedema (HAE) follow action plan, consult immunology

Child with Urticaria or Angioedema

ED Triage
Administer cetirizine

ED Team Assessment

Urticaria +/- Angioedema

Isolated Angioedema

If on ACE inhibitor
consult prescribing service

Acute Urticaria, < 6 wks

Chronic Urticaria, ≥ 6 wks

Consider additional cetirizine dose

Discharge

Improvement

No Improvement

Consider Immunology consult
Labs and dispo per Immunology recs
- Urine dipstick
- C4, C1q esterase inhibitor function

Consider additional cetirizine dose prior to discharge for persistent symptoms
Antihistamine regimen based
on symptoms
Follow up with PCP as needed

Consider additional cetirizine dose
Antihistamine regimen based
on symptoms
Follow up with PCP
- Consider allergy referral if no improvement in symptoms

Discharge

Antihistamine regimen
Consider referral to allergy

Posted: February 2025

Authors:
- T. Arceri, MD;
- A. Navard-Keck, MD;
- J. Lee, MD;
- A. Iqbal, MD;
- T. Brown-Whitehorn, MD;
- M. Larijani, MD;
- G. Murray, MD;
- A. Layman, MD;
- J. Katz, DO;
- L. Becton, MD;
- S. Sethi, MD;
- M. Lucas, MD;
- M. Brodnik, MSN;
- G. Sharer, MSN;
- K. Hummel, PharmD

Evidence

CHOP Programs

Division of Allergy and Immunology

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Emergency Department and Primary Care Clinical Pathway for Evaluation/Treatment of Children with Urticaria or Angioedema

Evidence

CHOP Programs