Urticaria — Angioedema & Vasculitis

A 26-year-old develops transient pruritic wheals daily for 7 weeks without a clear trigger; exam otherwise normal. First-line therapy?

A 34-year-old with CSU remains symptomatic on standard-dose cetirizine. Next step per guidelines?

A 42-year-old with CSU refractory to high-dose H1 blockers. Best next add-on?

A 55-year-old on an ACE inhibitor develops recurrent lip/tongue swelling without hives, nonresponsive to antihistamines. Diagnosis?

The immediate management of progressive tongue/laryngeal swelling from ACE inhibitor angioedema is:

A 19-year-old with recurrent abdominal pain and episodic extremity swelling; family history positive; no urticaria. Screening lab during an attack?

For confirmed HAE (low C1-INH function), which drug is appropriate for acute attacks?

A woman with HAE is planning pregnancy. Preferred prophylaxis for procedures/delivery?

A 21-year-old swimmer faints after jumping into cold seawater; history of cold-induced hives. Key counseling?

Office test to confirm cold urticaria?

A 29-year-old has pinpoint pruritic wheals after hot showers/exercise; lesions last <1 hour. Best initial management?

Which feature favors anaphylaxis over isolated urticaria?

First-line treatment for anaphylaxis in clinic?

After anaphylaxis, which lab drawn within 1–3 hours supports mast cell activation?

A 32-year-old notes urticaria within 30 minutes of multiple different NSAIDs (ibuprofen, naproxen). Mechanism?

Management of NSAID-exacerbated cutaneous disease?

A 47-year-old with CSU asks about workup. Appropriate baseline labs?

A 30-year-old with dermographism has linear wheals after scratching. Bedside confirmation?

A 59-year-old with tender wheals lasting >24 hours that heal with bruising and postinflammatory hyperpigmentation; low C3/C4. Diagnosis?

First-line treatment for normocomplementemic urticarial vasculitis without systemic disease?

A 68-year-old with new angioedema, low C1q, low C4, and low C1-INH function but no family history. Diagnosis?

A 24-year-old with CSU controlled on omalizumab asks about pregnancy. Which is true?

A 17-year-old has “urticarial” plaques and fever after amoxicillin; arthralgia and lymphadenopathy present; lesions last >24 h. Likely syndrome?

A 36-year-old jogger gets wheals and dyspnea only when exercising after eating wheat. Diagnosis?

Best daily controller for chronic inducible urticaria (e.g., cold, cholinergic)?

A 41-year-old with CSU uncontrolled on omalizumab after 6 months. Next-line steroid-sparing agent?

A 22-year-old with solar urticaria gets wheals within minutes of sunlight. Confirmatory test?

A 50-year-old reports delayed deep pain/swelling of hands after carrying groceries; lesions at 8–12 hours. Type?

A patient with HAE needs dental extraction. Short-term procedural prophylaxis?

A 37-year-old has recurrent angioedema with urticaria responsive to antihistamines. What distinguishes this from HAE?

A 58-year-old with palpable purpura on legs and arthralgias after new antibiotic; biopsy: leukocytoclastic vasculitis with immune complexes. Initial management?

A 45-year-old with HIV/HCV presents with purpura, arthralgias, neuropathy, low C4, positive cryoglobulins. Skin-directed measure?

A 33-year-old develops hives within minutes of showering regardless of temperature; no visible wheals, only pruritus. Likely type?

A 24-year-old with CSU asks about diet elimination. Best advice?

A 40-year-old with recurrent immediate hives when taking any ASA/NSAID, but tolerates acetaminophen. Safe analgesic option?

A child with “urticarial” annular plaques and swelling of face/hands after a URI; afebrile; lesions resolve within 24 h and recur elsewhere. Diagnosis?

Which medication commonly worsens or triggers angioedema in HAE patients and should be avoided?

Long-term prophylaxis for frequent HAE attacks?

A 52-year-old with CSU is well-controlled on levocetirizine 4× dose. He asks about safety. Counseling?

A 60-year-old with urticarial lesions for >24 h, burning pain, residual hyperpigmentation, arthralgias, and low C1q antibodies. Extra-systemic risk?

A 29-year-old with CSU controlled on high-dose cetirizine wants to stop all meds after 2 weeks symptom-free. Best counsel?

A 38-year-old with recurrent lip/tongue swelling without hives after starting an ARB (losartan). Prior ACE inhibitor angioedema 2 years ago. Guidance?

A 25-year-old nurse develops immediate pruritic wheals where latex gloves contact skin and lip swelling after banana. Diagnosis?

A 42-year-old with cholinergic urticaria asks about provocation testing. Appropriate method?

A 61-year-old with cryoglobulinemic vasculitis has painful purpura and neuropathy. Besides antivirals for HCV, which adjunct helps severe flares?

A 33-year-old with CSU develops delayed, painful swelling of palms after carrying boxes; lesions peak at 10 hours. Daily controller beyond antihistamines?

A 17-year-old with cold urticaria controlled on daily antihistamine asks about desensitization. Best advice?

A 45-year-old with recurrent hives and arthralgia; SPEP shows IgM monoclonal gammopathy. Diagnosis to consider?

A 6-year-old with palpable purpura, abdominal colic, and hematuria. First-line symptom control for gut pain?

A 28-year-old with suspected HAE has normal C1-INH and normal C4 during attack; episodes triggered by estrogen. Most likely type?

A 50-year-old with solar urticaria avoids sun but remains symptomatic. Next disease-modifying option?

A 36-year-old with CSU has poor sleep due to nocturnal itch despite daytime cetirizine up-dosed. Nighttime add-on?

A 41-year-old with recurrent angioedema + flushing, syncope; baseline tryptase persistently elevated. Suspected disorder?

A 22-year-old athlete has hives and hypotension only when exercising after eating shrimp. Long-term prevention?

A 58-year-old with LCV limited to legs after amoxicillin completes a 10-day course. Still has mild purpura. Best next step?

A 47-year-old with HAE on lanadelumab asks about self-management kit. What should she keep at home?

A 32-year-old with urticarial plaques lasting >24 h; biopsy shows neutrophilic urticarial dermatosis without immune complex vasculitis. What systemic disease should be considered?

A 40-year-old with CSU partially controlled on omalizumab 300 mg every 4 weeks. Evidence-based escalation?

A 24-year-old with vibratory angioedema gets swelling at sites of power tool use. Management?

A 70-year-old with new urticaria, weight loss, and night sweats. Appropriate workup step?

A 55-year-old with suspected hypocomplementemic urticarial vasculitis has hematuria and proteinuria. Next test?

A 43-year-old with acquired C1-INH deficiency due to lymphoma presents with facial angioedema. Beyond acute therapy, disease-modifying step?

A 27-year-old with chronic inducible solar urticaria wants non-drug prevention.

A 31-year-old with CSU asks about H2 blockers and leukotriene antagonists. Role?

A 19-year-old with urticaria after hot showers and spicy foods also gets flushing; tryptase normal; symptoms brief. Likely type?

A 48-year-old with Henoch–Schönlein purpura (IgA vasculitis) develops severe renal involvement. Steroid-sparing option?

A 52-year-old with CSU considering cyclosporine asks about monitoring. Key parameters?

A 28-year-old pregnant woman with severe HAE attacks. Safe acute agent?

A 40-year-old with CSU and autoimmune thyroiditis asks if treating thyroid helps hives.

A 34-year-old gets immediate wheals at site of cat lick. Diagnosis and plan?

A 63-year-old with long-standing CSU controlled on omalizumab for 9 months asks about stopping. Best strategy?

A 22-year-old with aquagenic urticaria has immediate wheals after showers; antihistamines help partially. Adjunct?

A 49-year-old with CSU reports that alcohol reliably triggers flares. Mechanism/counsel?

A 58-year-old with recurrent “urticaria” has fixed round plaques in same location after naproxen, leaving brown macules. Diagnosis?

A 27-year-old with HAE asks about long-term non-biologic prophylaxis if biologics unavailable. Option?

A 39-year-old with livedoid vasculopathy and recurrent ankle ulcers has no autoimmune markers. Antithrombotic of choice?

A 26-year-old with inducible dermatographism seeks lifestyle tips.

A 51-year-old with purpura and ulcers on calves in winter; plasma (not serum) shows precipitate at 4°C. Diagnosis?

A 44-year-old with CSU on cetirizine 20 mg BID has bothersome drowsiness. Reasonable adjustment?

A 37-year-old with ACE inhibitor angioedema is intubated for airway compromise. In ED, which medication is most likely to help resolution?