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Stabilization priorities
Immediate threats screen
Airway compromise signs
Voice change
Stridor
Tongue or floor of mouth swelling
Breathing compromise signs
Wheeze
Hypoxemia
Circulation compromise signs
Hypotension
Syncope
If anaphylaxis criteria met, initiate epinephrine IM immediately Class I
Do not delay for antihistamines or steroids
Repeat epinephrine IM every 5 to 15 minutes if ongoing compromise
Monitoring and access
Continuous pulse oximetry for respiratory symptoms
Frequent reassessment for progression from urticaria to anaphylaxis
Peak expiratory flow if bronchospasm and cooperative
IV access if systemic symptoms or angioedema
Crystalloid bolus if hypotension
Cardiac monitoring if epinephrine given or significant comorbidity
Key decision points
Phenotype
Urticaria without angioedema
Target symptom control with H1 antihistamine first line Class I
Discharge common if stable
Urticaria with angioedema
Airway risk stratification
Observation if facial or oral involvement
Isolated angioedema without hives
Bradykinin mediated pathway concern
ACE inhibitor exposure check
Trigger identification and removal
Medication exposures
NSAIDs
Antibiotics
Food exposure
Timing within minutes to 2 hours for IgE mediated pattern
Physical triggers
Heat
Cold
Escalation triggers
Progression pattern
New respiratory symptoms
New hypotension
Refractory symptoms
Persistent angioedema with airway involvement
Poor response to first line therapy
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.