The problem is usually self-limiting and lasts less than 4 weeks. Atarax or Benadryl are the standard symptomatic treatment for urticaria. Unfortunately, sedation often is a side effect with these medications. Lab testing or specialty consultation is generally not necessary. The sudden onset of edema of the lips, face, or tongue is typical of allergic angioedema associated with ACE inhibitors and other medications.
Airway management is imperative.
See the Anaphylaxis chapter for the management of this condition. In contrast to the acute variety, it is only rarely caused by IgE mechanisms such as food or drug allergy. In fact, more than 90 percent of the cases turn out to be idiopathic, or of unknown cause. The prognosis for eventual spontaneous resolution is good, and most of the patients are healthy adults for whom the symptoms are nothing more than a nuisance. However, rare cases are associated with underlying malignancy, liver disease, autoimmune disease such as lupus, and inapparent infection, so a careful history, review of systems, and physical exam is recommended.