Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 24F 57, 190lbs Meds: Lexapro, Buspar, Zyxal, Allegra, Pepcid, metoprolol tartrate, NuvaringPMH: postural orthostatic tachycardia syndrome, mast cell activation syndrome, hypermobile Ehler Danlos syndrome, and Celiac diseaseOther background: moved to NYC over the summer, works in cardiac surgery and critical careBefore the past few weeks, I had symptoms well under control with meds and lifestyle.3 weeks ago, I woke up out of the blue with itchy, raised hives all over my entire body. I went to urgent care and got a 5 day run of prednisone and steroid cream. Hives continued to fade and pop up all over. A week later, I went to my allergist. She gave me hydroxyzine to manage itching. A few days before it started, I had gotten my flu shot and COVID booster (Pfizer). She said maybe it was a hypersensitivity reaction to one of the vaccines, and that wouldnt last more than a few weeks. We couldnt come up with another trigger other than maybe environmental due to the apartments heat kicking in or the weather changing to cold.After seeing her, things worsened. The hives have been terrible still. Ive been getting pain, hives, and swelling in my small joints (fingers, wrists, ankles). Today, my face started swelling too. I have no idea if its still a vaccine reaction, a new allergen, or something else. Its getting harder to manage and no new ideas from my drs. Any ideas?. ### Response: If you have urticaria, this is acute urticaria. They can both be managed the same way.Finding a "cause" for most urticaria in most patients is not a reasonable expectation. Laboratory and other evaluation is not evidence based. Following the evidence-based treatment approach in Figure 2 will greatly improve most patients: https://onlinelibrary.wiley.com/doi/10.1111/all.13397.