What are the recommended first-line treatments for acute urticaria in adults?

First-line treatment for acute urticaria in adults is to offer a non-sedating oral H1-antihistamine, such as cetirizine, fexofenadine, or loratadine, for up to 6 weeks, using clinical judgement to determine the duration of treatment.

If symptoms are severe, a short course of oral corticosteroids (for example, prednisolone 40 mg daily for up to 7 days) may be given in addition to the non-sedating antihistamine.

Identification and avoidance of any known triggers should also be part of management.

If symptoms improve, consider the need for further antihistamine treatment based on the underlying cause and symptom duration.

Do not repeat corticosteroid courses if rebound symptoms occur; seek specialist advice instead.