The urticaria consultation is the point of contact for all patients with acute and chronic urticaria or angioedema, regardless of the cause. It is therefore networked with almost all other outpatient functional areas and the ward of our dermatology clinic. We endeavour to register all patients with this clinical picture who are examined and treated in our clinic and to care for them via our urticaria consultation hour.

The term urticaria is synonymous with hives. Urticaria is a very common skin disease and can be categorised into acute (lasting < 6 weeks) and chronic (lasting > 6 weeks).

It manifests itself as an often very itchy rash with mostly red, but also pale wheals of varying size and arrangement ("as if you had reached into a stinging nettle"). The wheals are caused by excessive permeability of the skin vessels, resulting in an accumulation of fluid in the skin. This reaction is caused by the release of various inflammatory substances such as histamine, heparin, serotonin, hyaluronic acid and lipid mediators from the mast cells. Mast cells are white blood cells found in the skin, which are also found in large quantities in other organs such as the lungs and intestines. Mast cells are part of the body's own defence system. The messenger substances they produce are normally helpful as part of the body's inflammatory response in defence against invading pathogens. In urticaria, however, there is a dysregulation for an as yet unknown reason and the messenger substances of the mast cells are released excessively. This leads to itching and reddening of the skin as well as the wheal formation so typical of urticaria.

There are many causes of urticaria, but there are also many contributing factors. This is a major difficulty because doctors and patients are often looking for a "needle in a haystack". Some common

• Intolerance reactions to certain medicines, foods or additives contained in them (pseudoallergens)

• Physical factors such as heat, cold or pressure

• Chronic infections

• Autoimmune diseases

Hormonal disorders, psychological factors and stress can also play a role, but these are difficult to measure and therefore not always tangible.

In order to clarify the whole range of possible triggers, detailed questioning is required and then, in individual cases, targeted subsequent examinations. Special diet plans may also be used here. Unfortunately, these intensive diagnostic measures are far from being able to determine the specific causes of urticaria in all cases, meaning that causal therapy is often not possible.

If a cause for the urticaria has been found, it should of course be avoided or eliminated. Unfortunately, in many cases the cause cannot be found. Therapy is therefore focussed on alleviating the symptoms. An individualised treatment plan is required for each patient, which in most cases is based on the targeted use of modern antihistamines such as Zyrtec®, Aerius®, Xusal®, Telfast® and others. Local measures to improve the skin barrier and physically alleviate the symptoms, such as moist compresses, have a supporting effect. In severe flare-ups, short-term injections and infusions of cortisone-containing medication into the vein are also used. Once the acute flare-up has subsided for the time being, the patient can switch back to tablets and gradually reduce the dose.

Patients who have already experienced an acute attack of urticaria with swelling of the lips or tongue or shortness of breath are also prescribed a combination of emergency medication (emergency kit). This consists of an antihistamine, a bottle of cortisone-containing medication and an adrenaline-containing dosing aerosol.

The exact use of this "kit" will be discussed in detail with the patient when it is prescribed.

Angioedema, also known as Quincke's oedema, is an acute attack of circumscribed swelling of the deep layers of the skin that lasts up to 3 days. The face, hands, feet and genital area are particularly affected. Grotesque disfigurements can often occur. Swelling of the intestinal wall is also possible and is often characterised by abdominal cramps and diarrhoea. If the upper airways are also affected, there is a danger to life.

The range of causes is wide; angioedema can, for example, be the expression of an intolerance reaction or a hereditary disease based on the deficiency of a blood protein factor (C1 esterase inhibitor).
It is therefore particularly important to clarify the exact medical history, for example family history, direct connection with the intake of medication, food, pre-existing illnesses, chronic or acute infections and others. Due to the complexity of the possible causes, specific investigations must be carried out in each individual case.

Quincke's oedema can become life-threatening relatively quickly due to swelling of the larynx. You should therefore call an emergency doctor as quickly as possible and go to hospital as soon as possible. The situation can usually be improved quickly by administering targeted emergency medication, but in the most severe cases a tracheotomy may be necessary. Patients who have had angioedema need to be prescribed an "emergency kit", the use of which is explained to the patient in detail when it is prescribed. Genetic angioedema is a special case, where the decisive measure in an acute emergency is the administration of the missing blood protein factor.

We collate the examination results from all the departments involved and can thus expand the diagnostic procedure in a targeted manner.
Regular follow-up care and support is necessary and difficult detective work, especially with this disease.
Together with us, the individual medical history can be precisely researched over the course of the disease.
The necessary drug treatment can then be customised to the individual patient.
In both diagnostics and therapy, we provide the patient with an interface to possible new findings from clinical and theoretical research.

Patients with urticaria (wheals, swellings that appear and disappear spontaneously) usually present to the university outpatient clinic on their first visit to the dermatology clinic. There, the patient's medical history is first discussed, the skin is examined and laboratory tests are carried out. The doctors in the private consultation or the university outpatient clinic then refer patients internally to the allergy department and the urticaria consultation. Patients who have had to be admitted as inpatients are given an appointment for further treatment by the Urticaria Consultancy at the end of their inpatient stay.