Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Approaches to the diagnosis and management of chronic urticaria in children

  • Choi, Sun Hee (Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine) ;
  • Baek, Hey Sung (Department of Pediatrics, Gangdong Sacred Heart Hospital, Hallym University School of Medicine)
  • Received : 2014.10.09
  • Accepted : 2015.03.17
  • Published : 2015.05.10
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Abstract

Most guidelines for chronic urticaria (CU) in infants and children are based on limited pediatric evidence. Current evidence used to guide treatment in children is extrapolated from data focusing on older age groups. CU in children is a different and complex condition than that in adults. Furthermore, there is little published information regarding urticaria in Korean children. The aim of the present article is to review recent research on chronic childhood urticaria and improve the current understanding of its pathogenesis and management. The classification and definition of urticaria in adults also applies to children. CU is defined as a daily occurrence of spontaneous wheals, angioedema, or both for >6 weeks. The precise pathophysiology of CU is unknown and the rates of successful identification of a cause in children with CU vary from 20%-50%. There is no established laboratory test to evaluate the presence of urticaria. The natural course of childhood CU is undetermined, with limited reports discussing long-term outcomes. Second-generation H1 antihistamines are the cornerstone of management, while limited therapeutic drugs are available for adults.

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References

  1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014;69:868-87. https://doi.org/10.1111/all.12313
  2. Church MK, Weller K, Stock P, Maurer M. Chronic spontaneous urticaria in children: itching for insight. Pediatr Allergy Immunol 2011;22(1 Pt 1):1-8. https://doi.org/10.1111/j.1399-3038.2010.01120.x
  3. Caffarelli C, Cuomo B, Cardinale F, Barberi S, Dascola CP, Agostinis F, et al. Aetiological factors associated with chronic urticaria in children: a systematic review. Acta Derm Venereol 2013;93:268-72. https://doi.org/10.2340/00015555-1511
  4. Khakoo G, Sofianou-Katsoulis A, Perkin MR, Lack G. Clinical features and natural history of physical urticaria in children. Pediatr Allergy Immunol 2008;19:363-6. https://doi.org/10.1111/j.1399-3038.2007.00667.x
  5. Ibanez MD, Garde JM. Allergy in patients under fourteen years of age in Alergologica 2005. J Investig Allergol Clin Immunol 2009;19 Suppl 2:61-8.
  6. Tuchinda M, Srimaruta N, Habanananda S, Vareenil J, Assatherawatts A. Urticaria in Thai children. Asian Pac J Allergy Immunol 1986;4:41-5.
  7. Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Visitsunthorn N, Vichyanond P. Identification of the etiologies of chronic urticaria in children: a prospective study of 94 patients. Pediatr Allergy Immunol 2010;21:508-14.
  8. Kang HS, Shin MY. Clinical aspects of chronic urticaria in children. Korean J Pediatr 2009;52:205-12. https://doi.org/10.3345/kjp.2009.52.2.205
  9. Choi SY, Park HY, Ahn YM. Chronic urticaria in childhood: etiology and outcome. Pediatr Allergy Respir Dis 2006;17:38-47.
  10. Volonakis M, Katsarou-Katsari A, Stratigos J. Etiologic factors in childhood chronic urticaria. Ann Allergy 1992;69:61-5.
  11. Tsakok T, Du Toit G, Flohr C. Pediatric urticaria. Immunol Allergy Clin North Am 2014;34:117-39. https://doi.org/10.1016/j.iac.2013.09.008
  12. Wedi B, Raap U, Wieczorek D, Kapp A. Urticaria and infections. Allergy Asthma Clin Immunol 2009;5:10. https://doi.org/10.1186/1710-1492-5-10
  13. Lang DM, Hsieh FH, Bernstein JA. Contemporary approaches to the diagnosis and management of physical urticaria. Ann Allergy Asthma Immunol 2013;111:235-41. https://doi.org/10.1016/j.anai.2013.07.031
  14. Kauppinen K, Juntunen K, Lanki H. Urticaria in children. Retrospective evaluation and follow-up. Allergy 1984;39:469-72. https://doi.org/10.1111/j.1398-9995.1984.tb01970.x
  15. Sackesen C, Sekerel BE, Orhan F, Kocabas CN, Tuncer A, Adalioglu G. The etiology of different forms of urticaria in childhood. Pediatr Dermatol 2004;21:102-8. https://doi.org/10.1111/j.0736-8046.2004.21202.x
  16. Ahrens B, Beyer K, Wahn U, Niggemann B. Differential diagnosis of food-induced symptoms. Pediatr Allergy Immunol 2008;19:92-6. https://doi.org/10.1111/j.1399-3038.2007.00677.x
  17. Ehlers I, Niggemann B, Binder C, Zuberbier T. Role of nonallergic hypersensitivity reactions in children with chronic urticaria. Allergy 1998;53:1074-7. https://doi.org/10.1111/j.1398-9995.1998.tb03817.x
  18. Rajan JP, Simon RA, Bosso JV. Prevalence of sensitivity to food and drug additives in patients with chronic idiopathic urticaria. J Allergy Clin Immunol Pract 2014;2:168-71. https://doi.org/10.1016/j.jaip.2013.10.002
  19. Cavkaytar O, Arik Yilmaz E, Buyuktiryaki B, Sekerel BE, Sackesen C, Soyer OU. Challenge-proven aspirin hypersensitivity in children with chronic spontaneous urticaria. Allergy 2015;70:153-60. https://doi.org/10.1111/all.12539
  20. Brunetti L, Francavilla R, Miniello VL, Platzer MH, Rizzi D, Lospalluti ML, et al. High prevalence of autoimmune urticaria in children with chronic urticaria. J Allergy Clin Immunol 2004;114:922-7. https://doi.org/10.1016/j.jaci.2004.07.042
  21. Du Toit G, Prescott R, Lawrence P, Johar A, Brown G, Weinberg EG, et al. Autoantibodies to the high-affinity IgE receptor in children with chronic urticaria. Ann Allergy Asthma Immunol 2006;96:341-4. https://doi.org/10.1016/S1081-1206(10)61245-8
  22. Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child 2003;88:517-9. https://doi.org/10.1136/adc.88.6.517
  23. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, Pacharn P, Visitsunthorn N, Vichyanond P, et al. The natural history of chronic urticaria in childhood: a prospective study. J Am Acad Dermatol 2014;71:663-8. https://doi.org/10.1016/j.jaad.2014.05.069
  24. Harris A, Twarog FJ, Geha RS. Chronic urticaria in childhood: natural course and etiology. Ann Allergy 1983;51(2 Pt 1):161-5.
  25. Grattan CE, Humphreys F; British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Guidelines for evaluation and management of urticaria in adults and children. Br J Dermatol 2007;157:1116-23. https://doi.org/10.1111/j.1365-2133.2007.08283.x
  26. Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy 2007;37:631-50. https://doi.org/10.1111/j.1365-2222.2007.02678.x
  27. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014;133:1270-7. https://doi.org/10.1016/j.jaci.2014.02.036
  28. Hsu ML, Li LF. Prevalence of food avoidance and food allergy in Chinese patients with chronic urticaria. Br J Dermatol 2012;166:747-52. https://doi.org/10.1111/j.1365-2133.2011.10733.x
  29. Kulthanan K, Jiamton S, Rutnin NO, Insawang M, Pinkaew S. Prevalence and relevance of the positivity of skin prick testing in patients with chronic urticaria. J Dermatol 2008;35:330-5. https://doi.org/10.1111/j.1346-8138.2008.00477.x
  30. Ministry of Food and Drug Safety [Internet]. Cheongju: Ministry of Food and Drug Safety; [cited 2015 Jan 30]. Available from: http://www.mfds.go.kr/index.do.
  31. Greaves MW. Chronic urticaria in childhood. Allergy 2000;55:309-20. https://doi.org/10.1034/j.1398-9995.2000.00116.x
  32. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P; Neo-I-30 Study Group. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 2006;55:705-9. https://doi.org/10.1016/j.jaad.2006.04.078
  33. Maurer M, Rosen K, Hsieh HJ, Saini S, Grattan C, Gimenez-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med 2013;368:924-35. https://doi.org/10.1056/NEJMoa1215372
  34. Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol 2013;132:101-9. https://doi.org/10.1016/j.jaci.2013.05.013

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