Urticaria +/- angioedema: when occurring in the absence of systemic features of allergy as above. Urticaria/angioedema is usually not caused by allergy or specific triggers and should not be referred see 2a-d, below. Follow national guidelines at: www.dermatology.nhs.scot/dermatology-pathways/
1. The following suggest symptoms MIGHT be allergic (may refer as above):
a. Symptoms ONLY within minutes of exposure to single food/food group
b. Symptoms ONLY with exercise/activity
c. Symptoms occur within minutes of exposure to latex
2. The following suggest urticaria/angioedema is NOT allergic
a. Symptoms are present first thing in the morning
b. Symptoms persist (even in varying intensity) for days / weeks
c. Symptoms have been frequent and regular over a period > 6 weeks d. Symptoms have occurred while on ACE inhibitor or NSAID therapy.
(Duration of prior therapy does not affect the chances of angioedema being related to a drug).
Angioedema WITHOUT urticaria: unless there are features to suggest allergy as in 1a-c, above, consider Immunology referral. Angioedema is rarely due to allergy or specific triggers.
Food Intolerance: no dedicated service available.
Rhinitis/Asthma: this falls under the remit of ENT/respiratory medicine.
Eczema/Dermatitis: this falls under the remit of Dermatology.