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Acute urticaria is better managed with oral antihistamines but if they are not effective many practitioners prescribe systemic steroids to provide the patient with short-term reliefif the rash recurs. For patients with the need to maintain a therapeutic dose of corticosteroids, oral corticosteroids are effective for 5-14 days but are usually used for 5-7 days for those with persistent or severe acute exacerbation, although a combination of oral steroids combined with steroids applied to the skin will usually have the desired effect within the first week [22, 23]. Antihistamines should be used cautiously because they can increase the risk of drowsiness . A recent meta-analysis showed that antihistamines (in combination with steroids) had a positive effect in the reduction of symptoms from severe acute urticarial flare, although some side effects (including dryness or bloating) have been described [25, 26]. Antihistamine use should be followed by an adequate sleep period to avoid drowsiness. In patients with more severe acute exacerbation, antihistamines are sometimes recommended to avoid excessive drowsiness and hyperphagia .Pulmonary Hypertension Pulmonary hypertension can occur in the absence of a clinical diagnosis of acute exacerbation when acute exacerbation was seen during a previous exacerbation. If this occurs, the patient should be observed for a few days (12-14 days) because it increases the risk of progression from pulmonary hypertension to sudden death . Pulmonary hypertension is uncommon when acute exacerbations are seen because airway hypercoagulation usually resolves spontaneously in most patients when airway pressure is maintained at about 40/45 mm Hg. This may be the only indication for a pulmonary resuscitation . Pulmonary hypertension can be clinically identified through examination of the chest wall including a pulse examination (Pulse Pressure (PP) and Respiratory Index (RI) , which is an early diagnostic sign for pulmonary hypertrophy . It has been shown that a rise in PPP from normal to abnormal is sufficient to indicate an acute exacerbation [32–34]. In severe acute exacerbations, PPP may be normal or even elevated, which may indicate a worsening pulmonary contusion. Acute exacerbations of pulmonary hypertension can be detected during an ECG; it is not required to have the presence of PPP in an ECG to detect pulmonary hypertension [35, 36].Liver Disease The diagnosis of acute exacerbations of acute liver failure (ALF) is usually made as soon as possible and at the first signs of the illness. It is generally not appropriate for more than 3 weeks to suggestSimilar articles: