Urticaria

QUESTION 7

A 32-year-old woman presented to the emergency department (ED) with acute onset hives. While in the ED she was treated with intramuscular methylprednisolone and intravenous diphenhydramine with complete resolution of her symptoms. Eight weeks after her ED visit, she continued to have intermittent hives more than 5 days a week. The hives were unresponsive to loratadine 10 mg daily so she decided to visit a dermatologist. On examination, there are numerous annular and geographic edematous plaques on the inner thighs and upper back (7). Upon further questioning, she denies worsening with pressure, cold, heat, water or exercise.