Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta‐analysis

Abstract

Background and objectives Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population‐based studies worldwide. Methods We performed a systematic search in PUBMED and EMBASE for population‐based studies of cross‐sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta‐analysis, we used a random effects model. Results Eighteen studies were included in the systematic evaluation and 11 in the meta‐analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I2) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%‐CI 0.5‐2.9) than those from Europe (0.5%, 0.2‐1.0) and Northern American (0.1%, 0.1‐0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex‐specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time. Conclusions On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex‐specific population‐based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020

“…This confirms that CU is a common disease. Interestingly, new data also show that the prevalence of CU in children is as high as or higher than in adults, estimated on average at 1% [1]. In three studies that included both children and adults, the prevalence did not differ significantly between both age groups [4][5][6].…”

“…This was especially so in the studies from Asia (Taiwan and Korea) [5,9]. Geographical regions with a high point prevalence were Latin America and Asia with estimates of 1.5 and 1.4%, respectively [1]. In contrast, North America showed by far the lowest point prevalence.…”

“…A recently published systematic review [1] with metaanalyses on the prevalence of chronic urticaria (CU) revealed three major insights: (1) CU is just as common in children as it is in adults; (2) the prevalence of CU is increasing; (3) there are substantial differences in the prevalence of CU across geographical regions.…”

“…Rates of concomitant autoimmune diseases tend to be higher in type IIb [25,[118][119][120][121] Rates of concomitant allergic diseases might be higher in type I [119] Total IgE levels low in type IIb and normal or high in type I [14,25] Basopenia rates might be higher in type IIb [24, 111] 2 Eosinopenia rates tend to be higher in type IIb [122] C-reactive protein levels may be higher in type IIb [25,123] ANA positivity rates may be higher in type IIb [124] Responder rates to sgAHs may be lower in type IIb [122][123][124][125] Responder rates to omalizumab high in type I [28] and low in type IIb [62,122,126] Speed of response to omalizumab slow in type IIb [127] Immunosuppressive therapy can be effective in type IIb [128-134] 3 TPO, thyroperoxidase; TG, thyroglobulin; TF, tissue factor; IL, interleukin; dsDNA, double-stranded DNA; BHRA, basophil histamine release assay; BAT, basophil activation test; ASST, autologous serum skin test; WB, Western blot; ELISA, enzyme-linked immunosorbent assay; CRP, C-reactive protein; ANA, antinuclear antibodies; sgAHs, second-generation antihistamines. 1 Measured by ELISA or radioimmunoassay. 2 In one study, IgE-anti-IL-24 levels showed a correlation with disease activity and a negative correlation with blood basophil counts.…”

“…They are widely used in clinical practice and trials, and they assess disease activity, impact, or control. Why is it impor- 1 The UAS is available in several languages. The original source is the EAACI/GA 2 LEN/ EDF/WAO urticaria guideline.…”