D-dimer concentrations in acute urticaria in children

Abstract

Introduction: Urticaria is a clinical entity presenting as wheals, angioedema, or both simul-taneously. Elevated D-dimer levels were reported in the course of chronic spontaneous urticaria. Data regarding D-dimer levels in acute urticaria in children are limited. Objectives: To assess potential associations between duration of glucocorticosteroid (GCS) therapy and D-dimer concentrations in children with acute urticaria. Patients, materials, and methods: Hospital records of 106 children (59 females), aged 5.57 ± 4.91 years, hospitalized in 2014–2018 were analyzed retrospectively. The study group consisted of pediatric patients admitted to the hospital due to severe acute urticaria resistant to anti-histaminic treatment that was ordered in the ambulatory care (out-patient clinic). Patients were divided into subgroups: no GCS treatment, short-duration treatment (up to 5 days) and long-duration treatment (6 and more days) GCS treatment. Simultaneously, patients received antihistaminic drugs. D-dimer level and other inflammatory factors such as white blood cell (WBC) count, platelet (PLT) count, and C-reactive protein (CRP) in each group were analyzed. Results: The D-dimer level was elevated in 51% of cases. In the subgroup with longer GCS treatment, D-dimer concentration was significantly higher in comparison to patients with a shorter GCS course. There were no differences in the distribution of CRP, PLT, and WBC concentrations between these subgroups. Conclusions: In the studied group of children, there was a tendency for higher D-dimer levels in patients, who required a longer GCS treatment. This finding is hypothesis-generating and requires further investigation to confirm if D-dimers can be used as a prognostic factor in acute urticaria in children.

Analysis of blood count derivative parameters and selected biochemical and fibrinolysis parameters in children with urticaria

“…D-dimers are a fibrin degradation products formed by activation of the clotting cascade of blood and thrombin. Previously, elevated D-dimer levels have been found in patients with AU, including those requiring prolonged corticosteroid therapy [34]. According to Zhang et al in AU there is an association of elevated D-dimers with the severity of skin lesions, moreover, high IgE levels may promote activation of the coagulation system in an extrinsic mechanism [35].…”

What do we currently know about urticaria in children?

“…Cases of urticaria in COVID-19 have also been reported [18]. The development of AU may also be associated with bacterial infections (Streptococcus, Staphylococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae, Helicobacter pylori) and in a small percentage with parasitic infestations (Ascaris lumbricoides, Giardia lamblia, Anisakis simplex, Toxocara canis, Echinococcus granulosus, Strongyloides stercoralis) [11,15,17].…”

“…Infections most commonly involve the upper respiratory tract and gastrointestinal tract, less commonly the lower respiratory tract or urinary tract [15,16]. Viral infections, including those caused by adenoviruses, enteroviruses, RSV, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus, influenza and parainfluenza viruses, are the most common etiologic agents [15,17]. Cases of urticaria in COVID-19 have also been reported [18].…”

“…Contrary to popular belief, food allergies are not among the predominant factors in the development of AU. Many foods such as eggs, milk, soy, nuts, wheat, and seafood can trigger hypersensitivity reactions [4,17,19]. In children, this mechanism is observed more frequently than in adults.…”

Severe acute urticaria is associated with elevated plasma levels of D‐dimer

“…Zaryczański et al. found that children with AU who had higher D‐dimer levels required prolonged glucocorticoid (GC) treatment 6 . Some small‐scale case reports have shown that AU seems to be more correlated with elevated plasma D‐dimer levels than CU 7 .…”