Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients

Abstract

The etiologies of chronic urticaria (CU) in childhood remains incompletely understood because of limited data in children. The objective of this study was to examine some of the possible etiologies of CU in children by focusing on the functional autoantibody to FcepsilonRIalpha and IgE, thyroid autoimmunity, urticarial vasculitis, parasitic infestation and food allergy. Children 4-15 yr of age with CU were investigated for complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), CH(50), free-T4 (FT(4)), thyroid stimulating hormone (TSH), anti-thyroglobulin and anti-microsomal antibody, autologous serum skin test (ASST), skin prick tests (SPT) for foods, food challenges, and stool examination for parasites. Ninety-four children who met the criteria for CU were recruited. Patients with physical urticaria were excluded. Eosinophilia and elevated ESR were found in 23% and 13%, respectively. High ANA titers were found in 2%. None of these patients had clinical features of urticarial vasculitis, abnormal CH(50) level, abnormal TSH and FT(4). Anti-thyroglobulin and anti-microsomal antibodies were not detected. Positive ASST was found in 38%. There were no differences in medication requirement and CU remission between patients with positive and negative ASST. Parasites were found in 5% without clinical correlation. SPT to foods was positive in 35%. Positive food challenges were found in six/nine patients with positive history of food allergy and two/seven patients with negative history. Food avoidance was beneficial to the subgroup of patients with positive history of food allergy only.

Kronik ürtikerli olgularımızın etyolojik değerlendirmesi

“…Jirapongsananuruk ve ark. 'nın 20 94 KÜ tanılı çocukta yaptığı çalışmada sadece 2 hastada ANA titresi 1/160 üzerinde saptanmış olup, <1/180 ANA titresinin sistemik lupus açısından %100 oranında negatif prediktif değere sahip olduğu McGhee ve ark. 21 tarafından ileri sürülmüştür.…”

High-dose anti-histamine use and risk factors in children with urticaria

“…Brunetti et al (23) found no autoimmune diseases in any of 93 patients with chronic urticaria. In the other studies, the rate of increased anti-thyroid antibodies ranged between 1.1% and 4.3% (13,27).…”

“…The success of specifying triggering factors in urticaria ranges between 21% and 83% in different studies (10)(11)(12)(13)(14)(15)(16). In our study, we found no factors that could lead to urticaria in approximately one fifth of the children with acute urticaria, and in approximately half of the children with chronic urticaria.…”

“…Acute urticaria was observed more fre- Acute urticaria Chronic urticaria 0-3 4-6 7-9 10-12 13-15 [16][17][18] Age quently in children aged below ten years and chronic urticaria was observed more frequently in children aged 10 years and older. In the literature, the age range is 3-8 years for acute urticaria and 8.8-10.4 years for chronic urticaria in childhood (10,11,(13)(14)(15). The main reasons for the age difference between the two diseases may include triggering of acute urticaria, mostly by external factors; a shorter time period required for occurrence of symptoms in acute urticaria; development of chronic urticaria over a longer time period; and presence of autoimmune mechanisms in chronic urticaria.…”

Diagnostic Approach to Urticaria and Angioedema in Children

“…Çocuklarda semptomatik dermatografizm, kolinerjik ürtiker, soğuk ürtikeri ve gecikmiş basınç ürtikeri en sık belirlenen fiziksel faktörler-dir. Aynı çocukta birden fazla fiziksel faktörün rol oynayabileceği akılda tutulmalıdır (20,21) .…”