Urticaria Without Anaphylaxis — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsUrticaria Without AnaphylaxisORE Part 1

An adult patient develops widespread itchy urticaria shortly after treatment in the dental surgery. They are alert, can swallow, and have no lip or tongue swelling, wheeze, stridor, dyspnoea, hypotension or collapse. What is the most appropriate initial management?

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Correct answer: E — Give oral chlorphenamine 4 mg and observe for progression

This is a mild allergic reaction: the patient has urticaria alone and no airway, breathing or circulatory features of anaphylaxis. In a conscious adult who can swallow, give oral chlorphenamine 4 mg and monitor closely for deterioration. SDCEP states that dental practices may stock oral chlorphenamine for mild allergic reactions, and the UK SmPC supports 4 mg orally for adult urticaria. IM adrenaline is indicated if anaphylaxis develops, not for isolated skin signs. IV hydrocortisone is not first-line treatment for uncomplicated urticaria and should not replace antihistamine treatment. Neither immediate discharge nor emergency transfer is appropriate while symptoms require treatment and observation; escalation is required if respiratory or cardiovascular features emerge.

Reference: Scottish Dental Clinical Effectiveness Programme. Practice Support Manual: Medical emergency drugs, section on mild allergic reactions, 2026. https://www.psm.sdcep.org.uk/topics/medical-emergencies-and-life-support/medical-emergency-drugs/