Chronic spontaneous urticaria in children: Itching for insight

Abstract

While there is increasing information about the pathogenesis and treatment of chronic spontaneous urticaria (csU) in adults, there is little published information about csU in children. Consequently, most of the recommendations contained in current guidelines for the prevention and treatment of csU in infants and children is based on extrapolation of data obtained in adults. To rectify this, this review points out critical gaps in our knowledge and suggests strategies which may help us to improve our understanding of this condition. How common is csU in children? What do we know about its clinical presentation and the presence of useful biomarkers? What are its common underlying causes? What is the course of csU in children? How does csU affect the everyday life of children? What treatment options are available for children? To answer these questions, two separate types of information are required. The first is information about the prevalence of the condition in the community at large and how csU affects the everyday life of both the child-patient and the parent or carer. Because most csU cases in infants and children do not come to specialists but are treated by general practitioners or by parents using over-the-counter medications, these questions may be answered only by general population surveys or schools programmes. The second is clinical information including family history and disease presentation, the presence of biomarkers and comorbidities, objective measures of severity, frequency and duration of exacerbations, the response to therapy and the time to remission. Targeted questionnaires need to be developed and validated for these investigations. This has already begun in Germany with the establishment of the CU-KID Netzwerk (Email address: cu-kid@charite.de), the aim of which is to identify clinical centres and colleagues who treat children with urticaria and to initiate the information gathering described above.

Histamine and H1-antihistamines: Celebrating a century of progress

“…In patients with acute urticaria, H 1 -antihistamines have not been optimally studied; however, in randomized double-blind placebo-controlled trials lasting 18 months, cetirizine and levocetirizine are reported to reduce acute urticaria in young atopic children. 1,18,48,49,64 In patients with chronic urticaria, first-generation H 1 -antihistamines are used despite the absence of satisfactory randomized, placebo-controlled trials to support their efficacy and safety. In contrast, high-quality trials of second-generation H 1 -antihistamines, such as cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, bilastine, and rupatadine confirm that they decrease symptoms and improve quality of life (see Table E2).…”

“…48,72 This approach has not yet been validated in children. 49 For patients with severe chronic urticaria refractory to nonsedating H 1 -antihistamines, it can be helpful to add an H 2 -antihistamine, montelukast, omalizumab, cyclosporine, or dapsone and treat exacerbations with a glucocorticoid for 3 to 7 days. 48,72 Other.…”

The Turkish Guideline for the Diagnosis and Management of Urticaria-2016

“…Pediatrik popülasyonda ürtikere ait araştırmaların çok az sayıda ve kısıtlı olması nedeni ile yeterli bilgi olmamakla birlikte, yayınlanan bir derlemede yapılmış prevalans çalışmaları doğrultusunda çocuklarda KÜ'nün yetişkinlerden çok daha az görüldüğü bildirilmektedir. KSÜ'lü çocuklarda tiroid otoimmünitesi de yetişkinlere göre çok düşük olup yaklaşık %4,3 civarında bulunmuştur 139 . Yeni kuşak H1 antihistaminlerin uzun dönem güvenlik profilleri daha iyi olduğundan ürtiker tedavisinde ilk seçenek olarak önerilmektedir.…”

The Etiological Evaluation of Patients with Chronic Urticaria in Childhood

“…Çocuklarda kronik ürtiker etiyolojisi ile ilgili literatürde sınırlı veri mevcuttur. Tanımlanabilen etiyoloji oranı çocuklarda %21 ile %51 arasında değişmektedir (1,4). Belirlenen nedenler arasında enfeksiyonlar, parazitozlar, besin allerjileri, otoimmünite ve fiziksel faktörler sayılabilir (1).…”