TOPLINE:

Adults with urticaria who presented to a US urban ED were often treated with diphenhydramine and steroids rather than guideline-recommended second-generation antihistamines; angioedema and steroid use were predictors of repeat ED visits.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 159 patients who presented with urticaria to the ED of a safety-net hospital between 2023 and 2024.
• The mean patient age was 40.8 years; 56% of patients were women; 77.4% were Hispanic individuals and 19.5% were Asian individuals. Most cases of urticaria (81%) were generalized.
• Outcomes were the percentages of patients who revisited the ED for urticaria and who received outpatient follow-up with an allergy/immunology specialist.

TAKEAWAY:

• Overall, 17% of patients revisited the ED for urticaria. Patients with angioedema (odds ratio [OR], 22.8; P = .004) and those who received steroids during their previous ED visit (OR, 4.3; P = .03) had significantly higher odds of ED revisits.
• Patients with asthma had higher odds of following up with an allergist (OR, 31.9; P = .034); however, the overall rate of allergy/immunology outpatient follow-up remained low at 6.9%.
• Overall, 63.5% of patients had no identifiable triggers; among those with known triggers, food was most common (17.6%), and other triggers included physical stimuli, radiocontrast media, and systemic illnesses.
• Most patients (84.3%) received diphenhydramine in the ED, followed by systemic steroids (50.3%) and famotidine (47.8%), whereas only 3.1% received second-generation antihistamines.

IN PRACTICE:

"Our study highlights the need for educating non-A/I [allergy/immunology] healthcare providers on the appropriate management of urticaria and ensuring timely follow-up after discharge," the authors wrote. "This is important for effective treatment and addressing the broader psychosocial and economic dimensions of the disease," they added.

SOURCE:

The study was led by Dorde Jevtic, MD, Icahn School of Medicine at Mount Sinai, New York City. It was published online on October 6, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by the retrospective design, small cohort size, and absence of a comparator group.

DISCLOSURES:

The authors reported no funding source or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.