Natural History and Prognostic Factors of Chronic Urticaria in Children Aged < 2 Years: A Single‐Centered, Real‐World, and Retrospective Study

Chronic urticaria (CU) has an adverse effect on academic achievement and psychosocial development in children. We aimed to investigate the natural course of CU and to identify relevant factors associated with a poor CU prognosis in Korean children. We retrospectively analyzed 253 children with episodes of wheals or angioedema at least 3 times a week that persisted for at least 6 weeks. Clinical data and laboratory results were obtained from medical records and parental telephone interviews. Kaplan-Meier survival analysis and log rank tests were performed to assess the median time to remission of CU and prognostic factors. Median age at onset was 5.0 years (interquartile range, 2.5-9.1) and median follow-up period was 7.6 months (interquartile range, 3.9-19.7). Of 253 patients, 68.8% had chronic inducible urticaria and 31.2% had chronic spontaneous urticaria. Physical urticaria was the only cause of chronic inducible urticaria, and the most common physical urticaria was dermographism. Median duration to remission of CU was 10.2 months (95% confidence intervals, 8.0-12.5 months). Kaplan-Meier analysis revealed that 33.4%, 53.0%, and 71.2% of children were in remission at 6, 12, and 24 months, respectively, after the onset of CU. The presence of allergic sensitization was significantly associated with a poor CU prognosis in univariable and multivariable analyses (P=0.010 and P=0.014, respectively). Half of children with CU were in remission 10.2 months after onset. Allergic sensitization was a risk factor associated with longer duration CU.

BackgroundData on the natural history and prognostic variables of chronic urticaria (CU) are rare and information about spontaneous remission of CU is limited.ObjectiveThis study evaluated the natural history of CU and identified predictors for remission.MethodsTotal 329 Korean patients with CU, who had follow-ups more than 6 months after diagnosis during a 7-year period in the department of dermatology in three university hospitals were enrolled. Clinical data and laboratory findings obtained by medical records and telephone interviews were analyzed, retrospectively.ResultsThe proportion recovered in 1, 3, and 5 years after the onset of CU was 10.8%, 18.8%, and 32.9%, respectively. The mean duration of CU was 6.3 years. There were no significant differences in median recovery time depending on sex, age group, severity of CU, and type of CU. The presence of angioedema was significantly related to CU severity. There were no differences in prognosis with respect to the presence of dermographism or angioedema. Patients with atopic dermatitis (AD) had a significantly worse prognosis than patients without a history of AD; but not in patients with the history of allergic rhinitis or asthma. Patients with abnormal laboratory findings did not differ significantly in prognosis.ConclusionCU remission rate significantly differ according to the presence of AD. This study provides information about the natural course of CU of Korean patients.

The natural history of chronic urticaria in childhood: A prospective study

Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. To analyze the course and features of CU during and after pregnancy. PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item questionnaire completed by CU patients, who became pregnant within the last 3years. A total of 288 pregnancies of 288 CU patients from 13 countries were analyzed (mean age at pregnancy: 32.1±6.1years, duration of CU: 84.9±74.5months; CSU 66.9%, CSU+CIndU 20.3%, CIndU 12.8%).During pregnancy, 51.1% of patients rated their CU as improved, 28.9% as worse, and 20.0% as unchanged.CU exacerbations most commonly occurred exclusively during the third trimester (in 34 of 124 patients; 27.6%) or the first (28 of 124; 22.8%). The risk factors for worsening of CU during pregnancy were having mild disease and no angioedema before pregnancy, not taking treatment before pregnancy, CIndU, CU worsening during a previous pregnancy, treatment during pregnancy, and stress as a driver of exacerbations. After giving birth, urticaria disease activity remained unchanged in 43.8% of CU patients, whereas 37.4% and 18.1% experienced worsening and improvement, respectively. These results demonstrate the complex impact of pregnancy on the course of CU and help to better counsel patients who want to become pregnant and to manage CU during pregnancy.

Background: The term ‘urticaria’ is used to describe a disease that may present with wheals, angioedema or both. It is considered chronic when the attacks last > 6 weeks. A possible association between chronic urticaria and Helicobacter pylori infection (H. pylori) was suggested by a systematic review of therapeutic studies. Aim of the study: To investigate the role of H. pylori in patients with chronic ordinary urticaria and to evaluate the effect of H. pylori eradication on the clinical course of chronic urticaria. Patients and methods: A prospective case- control and therapeutic study was conducted on 135 patients with chronic ordinary urticaria and 186 apparently normal matched controls. All subjects were tested for H. pylori stool antigen and the presence of gastrointestinal symptoms was recorded. This followed by therapeutic study on a subgroup of patients with positive stool antigen test to assess the effect of triple eradication therapy of H. pylori including amoxicillin 1gm twice daily, clarithromycin 500mg twice daily and omeprazole 20mg twice daily for two weeks on the course of chronic urticaria by following them for six months using three points rating scale and the need for H1 blocker antihistamine as rescue medicine. Results: H. pylori stool antigen test was positive in 164(51.1%) subjects of the studied population, where 86 (63%) of patients with chronic urticaria have positive stool antigen test versus 78 (41%) among the control group with astatically significant difference(p value < 0.001, odd ratio 2.4). It was also observed that 91 (68.4%) %) out of 133 subjects with gastrointestinal symptoms had actually positive H. pylori infection using stool antigen test, this suggested that gastric symptoms and H. pylori infection was statistically associated (P < 0.001). Only 52 patients with chronic urticaria and positive H. pylori stool antigen test were completed the six months follow up period. The response to eradication therapy (complete remission + partial remission) was evident in 42 (80.8%) patients, that was found to be statistically significant (p value = 0.019) by comparing them with 10(19.2%) patients with no objective response. In general, no significant adverse effect was reported. Conclusions 1. There is a statistically significant association of Helicobacter pylori infection with chronic urticaria 2. Eradication of H. pylori is a valid therapeutic option for patients with chronic ordinary urticaria and positive stool antigen test as it induces complete and partial remission in 80.8% of the cases.

While the role of oestrogens in bradykinin angioedema (AE) has been clearly demonstrated, scarce data are available about the role of sex hormones in chronic urticaria (CU). To gather information from a population of women with various forms of CU [chronic spontaneous urticaria (CSU), including a subtype of isolated histaminic AE and a classic subtype of association of wheals and AE, and exclusive inducible urticaria (IU)] about the impact of sex hormones and reproductive factors on their symptoms. This was a cross-sectional study comprising interviews of 200 women consulting for CU at nine centres throughout France between May and July 2013. The dermatologists filled in an online questionnaire on the impact of reproductive factors (puberty, contraception and pregnancy) and hormonal treatments on the course of CU, including CSU and IU, in the presence of the women. Most of the women did not experience CU before puberty and if so, puberty did not influence the course of CU. Only 16 women had experienced a pregnancy during CU which caused a worsening of symptoms in four. Hormonal contraception was associated with aggravation in a minority of women, mostly women with CSU (10%). Women with isolated histaminic AE did not exhibit any female sex hormone dependency. It would appear that sex hormones act as a trigger in only a small subset of women with CU. Nevertheless, this should be taken into account to improve patient management.

Chronic urticaria (CU) is a systemic disorder which is characterized by recurrent wheals and/or angioedema lasting more than 6 weeks. Sex hormones have been suggested to play a role in CU pathogenesis, however, their clinical implications have not been adequately described in the literature. To determine whether conditions that change sex hormone levels such as puberty, menstruation, pregnancy, breastfeeding, and menopause affect the course of CU. This cross-sectional questionnaire study was conducted on female CU patients at Okmeydani Training and Research Hospital UCARE Center between 2016 and 2017. The open-ended questionnaire consisted of questions evaluating the effects of hormonal changes on disease course. A total of 111 female CU patients were included in the analysis. During the perimenstrual period, CU symptoms worsened in 29% of patients but improved in 4.8%. The disease course did not change in the majority of patients during puberty, pregnancy, lactation, or menopause (100%, 96%, 83.8%, and 95.6%, respectively). Contrary to expectations, a change in sex hormone levels had no effect on the course of CU in the majority of cases. However, disease activity increased in one-third of CU patients during the perimenstrual period.

This corrects the article on p. 390 in vol. 13, PMID: 33733635.

PurposeLittle is known about the clinical course of chronic urticaria (CU) and predictors of its prognosis. We evaluated CU patient clusters based on medication scores during the initial 3 months of treatment in an attempt to investigate time to remission and relapse rates for CU and to identify predictors for CU remission.MethodsIn total, 4,552 patients (57.9% female; mean age of 38.6 years) with CU were included in this retrospective cohort study. The K-medoids algorithm was used for clustering CU patients. Kaplan-Meier survival analysis with Cox regression was applied to identify predictors of CU remission.ResultsFour distinct clusters were identified: patients with consistently low disease activity (cluster 1, n = 1,786), with medium-to-low disease activity (cluster 2, n = 1,031), with consistently medium disease activity (cluster 3, n = 1,332), or with consistently high disease activity (cluster 4, n = 403). Mean age, treatment duration, peripheral neutrophil counts, total immunoglobulin E, and complements levels were significantly higher for cluster 4 than the other 3 clusters. Median times to remission were also different among the 4 clusters (2.1 vs. 3.3 vs. 6.4 vs. 9.4 years, respectively, P < 0.001). Sensitization to house dust mites (HDMs; at least class 3) and female sex were identified as significant predictors of CU remission. Around 20% of patients who achieved CU remission experienced relapse.ConclusionsIn this study, we identified 4 CU patient clusters by analyzing medication scores during the first 3 months of treatment and found that sensitization to HDMs and female sex can affect CU prognosis. The use of immunomodulators was implicated in the risk for CU relapse.

Abstract. Introduction. According to its definition, urticaria refers to a group of diseases characterized by the development of wheals, angioedema, or both. Most often, chronic urticaria is triggered by stress, hormonal drugs, consumption of products containing food colorants, preservatives, gastrointestinal diseases, autoimmune pathology, as well as by infections, including COVID-19. Due to the fact that the coronavirus epidemic set on relatively recently, the effect of this virus, as well as of SARS-CoV-2 vaccination, on the course of chronic urticaria has not been studied in sufficient detail. Aim. Evaluation of the impact of SARS-CoV-2 and COVID-19 vaccination on the course of chronic urticaria. Materials and Methods. The impact of SARS-CoV-2 and COVID-19 vaccination on the course of chronic urticaria was assessed in 100 patients from 2021 to 2023, using the questionnaire developed and the UCT questionnaire. Patients aged 39±15 years participated in the survey. Results and Discussion. The duration of chronic urticaria in most respondents (58%) was more than 2 years, and in only 7% less than a year. According to the UCT results, urticaria symptoms were controlled in 67% of patients before the SARS-CoV-2 epidemic. 64 people recovered from COVID-19; however, exacerbation of urticaria associated with SARS-CoV-2 was observed in 35.9% of patients, while the disease onset was found in 3.1% of them. It should be noted that exacerbation of urticaria developed during COVID-19 persisted in all patients for 3 months, and in a half of them for 6 months after the infection. 67 patients were vaccinated against COVID-19: 63 with Gam-COVID-Vac and 4 with CoviVac, while immunoprophylaxis was not recommended for 15 patients due to their uncontrolled urticaria. 23.8% patients vaccinated with Gam-COVID-Vac experienced fever and headache on the first day. Only 8% of patients experienced exacerbation of urticaria. Conclusions. Patients with chronic urticaria usually have a mild form of COVID-19. However, SARS-CoV-2 causes exacerbation or onset of urticaria in 35.9% of cases. Vaccination with Gam-COVID-Vac is well tolerated by patients with chronic urticaria, and only 8% of patients experience exacerbation of the disease.

Chronic urticaria is thought to have numerous causative factors including a large variety of infectious conditions, food intake, and drugs. The impact of Helicobacter pylori infection has been studied with ambiguous results. The aim of this study was to investigate the course of chronic urticaria in H. pylori-positive patients undergoing eradication compared to H. pylori-negative urticaria patients. We included 74 urticaria patients with positive H. pylori breath test and 74 age- and sex-matched H. pylori-negative controls. All urticaria patients underwent an extensive diagnostic work-up to search for trigger foci. H. pylori-infected patients were submitted to eradication therapy. Mean follow-up time was 58 months. Neither the prevalence of H. pylori nor the eradication therapy had an influence on the clinical course of chronic urticaria. In 81.1% of H. pylori-infected patients at least one additional infectious focus was found. Nevertheless, it could be shown that individuals that described any kind of symptom relief presented with higher serum IgE levels at diagnosis (198.1 vs 115.7 kU/L, p= .027) but this effect was independent of H. pylori infection. In conclusion there is no evidence that eradication of H. pylori improves the outcome in patients with chronic urticaria. The high rate of spontaneous remission and the coexistence of multiple foci will always obscure the evaluation of any specific antimicrobial therapy.

PurposeData specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU.Patients and methodsOriginal articles that included data of elderly (aged >60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.ResultsAmong the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2–2.8%, and from 0.7–33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU.ConclusionElderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.

Background: Chronic urticaria is a complex multifactorial dermatological disease characterized by wheals lasting more than 6 consecutive weeks. The resultant physical discomfort from chronic urticaria may worsen the patient’s quality of life. Emotional manifestations are shown to occur in these patients, among which, depression and anxiety are the two most common conditions. Accordingly, this study evaluates the role of anxiety and depression in the course of chronic urticaria. Materials and Methods: A total of 170 adult patients with chronic urticaria and 50 healthy adults were asked to complete the questionnaires to be evaluated for the presence of any stigma regarding anxiety and depression. The inclusion criteria were individuals 18 years of age and above, and suffering from chronic urticaria. Results: The mean age of healthy individuals (control group) was 38.255±13.44 years. Most of the patients (74%) were female. Anxiety was found in 59.5% of the patients with chronic urticaria and 42% of healthy control individuals (P=0.029). Depression was found in 17.6% of patients with chronic urticaria and 6% of healthy individuals (P=0.022). Conclusion: A strong relationship exists between chronic urticaria and emotional conditions, including anxiety and depression exists.

Despite the disabling nature of chronic urticaria (CU), little is known about the disease's duration or the efficacy of adopting aggressive therapeutic regimens such as cyclosporine A. The aim of this study was to evaluate whether parameters such as angioedema, autologous serum test, anti-thyroid antibodies, and total IgE could predict both CU duration and severity. One hundred and thirty-nine patients suffering from CU were prospectively followed over a 5-year period for disease duration, severity and the presence of angioedema. Also investigated was the association between these clinical parameters and the subsequent detection of autologous serum test, anti-thyroid antibodies, and total IgE. CU lasted over 1 year in more than 70% of cases and in 14% it still existed after 5 years. Angioedema co-existed or appeared during the course of CU in 40% of patients and was associated with disease duration. Autologous serum test and anti-thyroid antibodies were found positive in 28 and 12% of patients, respectively, compared to none of normal individuals, P = 0.001. CU duration was associated with the presence of both autologous serum test and anti-thyroid antibodies; however, autologous serum test and not anti-thyroid antibodies was found in association with CU severity. We demonstrate for the first time that CU duration is associated with clinical parameters such as severity and angioedema, and with laboratory parameters such as autologous serum test and anti-thyroid antibodies. The ability to predict CU duration may facilitate decisions regarding the possible early initiation of cyclosporine A as a means by which to reduce disease severity and duration.

The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.