Recurrent urticaria and angioedema

Abstract

<h2>Abstract</h2> Urticaria is common in childhood, affecting up to 15% of British children. It is characterised by the sudden onset of wheals, angioedema, or both. Episodes are usually acute, often triggered by viral infections ± antibiotics, with approximately a third progressing to chronic or recurrent urticaria. This review covers urticaria subtypes, diagnosis and treatment options for children. The diagnosis is usually made clinically, and a focused history is vital. Further investigations are usually unnecessary. Chronic urticaria is divided into chronic spontaneous urticaria and the inducible urticarias. Chronic spontaneous urticaria is autoimmune in origin, in approximately 40% of older children. Cold urticaria and dermographism are the most common inducible urticarias. Isolated angioedema should prompt consideration of hereditary angioedema. The mainstay of treatment is non-sedating antihistamines, often with higher doses than standard and avoidance of triggers. Tranexamic acid may provide symptomatic relief for isolated angioedema. Treatment options include leukotriene receptor antagonists, anti-IgE therapy and systemic immunosuppression in unresponsive patients. Short courses of oral steroids may be used in acute episodes or highly symptomatic patients with chronic urticaria. Urticaria usually resolves; the vast majority of patients are disease free after 7 years.