Chronic Urticaria in Children

Guidelines for managing chronic urticaria (CU) in children often rely on recommendations from adult studies, which lack a standardized diagnostic pathway. The effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids in children remains underreported. There is significant variation in CU remission rates across studies. A recent study aimed to improve the understanding of pediatric CU.

This was an observational study enrolled 37 children with CU, aged 0-18 years. Demographic data – medical history, clinical features, laboratory results, and treatment, were collected. Children received recommended doses of second-generation H1-antihistamines––with dosage increases up to twofold if necessary. Omalizumab was added for those unresponsive to anti-H1, and systemic glucocorticoids were used for severe flare-ups. Some children received montelukast.

It was found that wheals without angioedema were common. CU was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), parasite-induced in 1, and vasculitic in 2. Treatment of potential causes was generally ineffective, except for eradicating Dientamoeba fragilis. Within three years, 45.9% of the cases resolved. Allergic diseases were present in nine children (24.32%) and autoimmune diseases in three (8.11%). All children were treated with anti-H1 at recommended or higher doses, with 78.38% showing a partial or complete response. However, montelukast showed no benefit. All children treated with omalizumab responded positively. Systemic glucocorticoids were effective for exacerbations.

Routine laboratory tests are not recommended for children with CU unless clinically indicated. Monitoring for comorbidities like thyroid autoimmune disease and celiac disease is suggested. Increasing anti-H1 dosage and adding omalizumab are effective strategies in treatment-resistant cases, but further studies are needed to develop a standard treatment protocol. 

The results underscore the need to reassure parents about the benign nature of CU rather than conducting unnecessary tests. Monitoring associated conditions and developing new treatments are essential for better disease management in children.

Source: Buono EV, Giannì G, Scavone S, et al. Medicina. 2024 Apr 25;60(5):704