Managing urticaria and angioedema in dental practice

Urticaria is characterised by transient erythematous lesions that vary in size; they are often filled with fluid. Urticarial lesions persist for a few minutes to 24 hours and tend to be itchy.

Acute angioedema (oedema of the subcutaneous tissue) can coexist with urticaria, as single or multiple lesions. Angioedema can be painful or cause a burning sensation, but the lesions are usually not itchy. They can occur anywhere on the body, but often affect the face, periorbital region, lips, tongue, glottis, dorsa of feet and hands, and genitals. Angioedema usually resolves over several hours to days.

Acute urticaria or angioedema may be associated with anaphylaxis. If laryngeal swelling occurs, or there are other signs of anaphylaxis (bronchospasm, upper airway obstruction and hypotension), treat as anaphylaxis—see Management of anaphylaxis in dental practice for first-aid management in dental practice.

Consider drug causation, particularly in cases of acute reactions. However, delayed drug-associated reactions can occur after more than one dose of a drug—onset may be days after starting the drug. Urticaria may not immediately resolve when the drug is stopped.

Occasionally, urticaria can be caused by contact with a substance (contact urticaria). Advise the patient to avoid contact with the cause (eg latex rubber gloves) in the future.

In dental practice, follow the advice in Management of urticaria and angioedema in dental practice for first-aid management of patients with urticaria and angioedema.

Figure 1. Management of urticaria and angioedema in dental practice

For mild urticaria or angioedema:

  • Stop dental treatment.
  • Remove or stop administration of the allergen.
  • Recommend an oral antihistamine.

For extensive urticaria or angioedema, or swelling involving eyelids, lips or tongue:

  • Stop dental treatment.
  • Remove or stop administration of the allergen.
  • Refer for urgent medical attention; systemic corticosteroids may be indicated.

For urticaria or angioedema with associated hypotension and evidence of anaphylaxis: