Chronic Urticaria In Children Research Articles

Care and medical costs of urticaria in children in Germany : Drugs, medical and inpatient services

Data on the course of urticaria in children exist, but there is alack of sound data on patient management to ensure high-quality care. Retrospective secondary data analysis in the field of health care and epidemiology in children with urticaria based on routine data from aGerman health insurance company (DAK-Gesundheit). Data from insured persons under 18years of age who were treated as outpatients or inpatients with adiagnosis of urticaria (according to ICD-10 classification) in 2010-2015 were included. The control group consisted of children without acorresponding diagnosis, in order to clarify health economic and care-related differences after adjusting for age and gender. In 2015, 1904 (1.3%) of 151,248 insured minors had adiagnosis of urticaria. Of the children with urticaria, 70.9% visited at least one physician on an outpatient basis. Of these visits, 70.9% were made to apediatrician, 52.5% to ageneral practitioner and 33.0% to adermatologist; 11% were treated as inpatients. With atotal of 151,248 insured persons, 1904 of whom were diagnosed with urticaria, 72.9% of children and adolescents with versus 28.9% without urticaria were treated topically or systemically in 2015, including 10.5% of children with urticaria vs. 2.6% without urticaria received topical therapy and 70.0% with urticaria received systemic therapy vs. 27.5% without urticaria with systemic therapy. The most commonly used oral medications for urticaria were cetirizine (44.2%), prednisolone (9.8%), and dimetindene (2.0%) . Topical methylprednisolone aceponate (49.8%) was prescribed most frequently. The therapy costs for systemic drugs was € 24.00 per patient, while topical drugs cost € 1.58 per patient. The lack of guidelines for the standardization of treatment in children still leads to ambiguities and different treatment concepts among the specialist groups, which must be eliminated in order to enable more efficient therapies. The treatment of chronic urticaria in children and adolescents is mainly carried out by pediatricians, general practitioners and dermatologists. Systemic and topical medications as well as inpatient services are the most important cost factors.

Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study.

Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.

Blood Adhesion Molecules as Biomarkers in Children with Chronic Urticaria.

The prevailing etiological model of both acute and chronic urticaria implicates specific allergen exposure that triggers the local release of vasoactive factors and inflammatory adhesion molecules, including vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), endothelial leukocyte adhesion molecule 1 (ELAM-1), P-selectin and E-selectin in the superficial dermis. This study focused on the possible role of VCAM-1 and ICAM-1 as biomarkers in children with acute and chronic urticaria. This study involved 184 children, 40 with acute urticaria, 71 with chronic urticaria, and 73 matched comparison subjects. The serum levels of ICAM-1 and VCAM-1 were determined in venous blood in all the participants on enrollment. Antihistamine treatment was administered to all the patients. In the children with chronic urticaria, the Urticaria Activity Score Questionnaire (UAS7) was completed daily by the parents. In 16 of the patients with acute urticaria and 43 with chronic urticaria, the serum levels of ICAM-1 and VCAM-1 were determined at follow-up after 6-8 weeks of treatment. The mean serum levels of both VCAM-1 and ICAM-1 were higher in both groups of children with urticaria than in the comparison subjects at the start of the study. In the chronic urticaria group, the levels decreased significantly (p = 0.03 and p = 0.01, respectively) following treatment. Similarly, the acute urticaria group exhibited significant reduction in the mean levels of VCAM and ICAM (p < 0.001). In both groups, the mean level of ICAM after treatment was comparable with that of the comparison group. VCAM-1 and ICAM-1 are suggested as promising biomarkers for monitoring both acute and chronic urticaria in children. Future research should explore their utility in larger cohorts and investigate their role in personalized treatment strategies.

Chronic spontaneous urticaria in children: Series of 16 cases

IntroductionChronic urticaria is an inflammatory dermatosis induced by mast cell mediators and is characterized by the occurrence of superficial urticarial plaques and/or angioedema for more than 6weeks. Its prevalence in children is lower than acute urticaria, but its impact on daily life can be major. We report a series of 16 cases of chronic spontaneous urticaria in children. Materials and methodsRetrospective study including 16 children with chronic urticaria evolving for more than 6weeks between January 2018 and April 2022. ResultsSixteen patients were included in the study. The mean age of the patients was 7.4years with extremes ranging from 3 to 10years. A female predominance was observed with a sex ratio M/F of 0.50. The mean time to consultation was 8.54months. A typical clinical picture of migrating and fleeting pruritic erythematous papules and plaques evolving by flare-ups and remissions was found in all patients. Angioedema was associated in 3 children. Physical examination revealed dermographism in 3 cases. The etiological investigation led to the conclusion of idiopathic urticaria in all children. The treatment prescribed in our patients was second-generation anti-H1 antihistamines, in particular desloratadine (2 to 3 times the dose) for at least 6months with a good evolution. DiscussionThe originality of this work lies in the rarity of chronic urticaria in children. This series confirms the predominance of the disease in women and the association with family or personal atopy. Treatment is based on second-generation anti-H1 antihistamines, the dose being doubled or quadrupled in case of ineffectiveness as described in our patients. Its management is often made difficult because of its important impact on the quality of life and a sometimes insufficient response to the first-line treatment.

Urticaria and angioedema in children and adolescents: diagnostic challenge.

Urticaria diagnosis may be challenging in children since it can be triggered or related to numerous conditions. In this paper, we reviewed the main aspects regarding the diagnosis of urticaria in the pediatric population. Acute urticaria is often due to viral infections. However, other culprits, including foods, insect stings, drugs, contrast media, vaccination, latex, and medical diseases, may account for acute patterns. Laboratory tests and confirmatory allergy tests should be individualized and guided by history. Chronic urticaria (CU) is defined when hives and/or angioedema last for more than 6 weeks. The most common type of chronic urticaria in children is chronic spontaneous urticaria (CSU). Chronic inducible urticaria (CindU) is less common but is important to diagnose in order to manage appropriately and reduce the risk of severe reactions. Inducible forms in children are often diagnosed with specific provocation tests similar to the tests used in adults. Given that chronic urticaria could rarely be a presentation of vasculitis, systemic-onset juvenile idiopathic arthritis, or auto-inflammatory syndromes, it is important to rule out these conditions. It is crucial to differentiate cases of chronic urticaria from mastocytosis and Bradykinin-mediated angioedema, given that treatment may differ. The management of chronic urticaria in children has improved over the last decade because of the development of both clear management guidelines and new effective drugs. It is crucial to increase awareness for appropriate diagnosis and new available treatment to improve the management of chronic urticaria in children.

Natural History and Influencing Factors of Chronic Urticaria in Children.

PurposeChronic urticaria (CU) can reduce the quality of life of children and their parents, but there are only a few studies on the course of CU in children. This study aimed to investigate the natural course of CU in children and identify the factors that influence its prognosis.MethodsWe evaluated 77 children diagnosed with CU, who were monitored for at least 48 months. Subjects were classified as either chronic spontaneous urticaria (CSU) or other CU, and the clinical features were compared. Remission was defined as having no symptoms without treatment for more than 1 year. The remission rate was analyzed, and the factors influencing the prognosis were investigated.ResultsThe average age of the study population was 5.96 ± 4.06 years, and 64 (83.1%) patients had CSU. The remission rates at 6 months, 1 year, 2 years, 3 years, and 4 years after symptom onset were 22.1%, 40.3%, 52.0%, 63.7%, and 70.2%, respectively, for children with CU. For children with CSU, these values were 23.4%, 43.7%, 56.2%, 68.7%, and 75.0%, respectively. The total serum immunoglobulin E (IgE) levels were positively correlated with disease duration (r = 0.262, P = 0.021); no other factors were associated with the duration of the disease.ConclusionsA high proportion of children with CU were classified as CSU. No indicators, except for total IgE were found to predict the timing of spontaneous remission. The CU remission rate identified in this study is expected to be used as one of the reference data for the progress of CU in patients.

Immunological Targets of Biologic Drugs in Allergic Skin Diseases in Children.

Atopic dermatitis and urticaria are two invalidating skin disorders that are very common in children. Recent advances in the understanding of their specific intracellular molecular pathways have permitted the development of precise biological molecules, targeting inflammatory mediators and arresting the pathogenetic pathways of skin diseases. Many biologics with promising results have been studied, although few are currently approved in children. In this review, we aim to provide the latest evidence about the use, indications, efficacy and safety of biologic therapies to treat atopic dermatitis and chronic urticaria in children and adolescents.

A European survey of management approaches in chronic urticaria in children: EAACI pediatric urticaria taskforce.

Although well described in adults, there are scarce and heterogeneous data on the diagnosis and management of chronic urticaria (CU) in children (0-18years) throughout Europe. Our aim was to explore country differences and identify the extent to which the EAACI/GA²LEN/EDF/WAO guideline recommendations for pediatric urticaria are implemented. The EAACI Task Force for pediatric CU disseminated an online clinical survey among EAACI pediatric section members. Members were asked to answer 35multiple choice questions on current practices in their respective centers. The survey was sent to 2,773 physicians of whom 358 (13.8%) responded, mainly pediatric allergists (80%) and pediatricians (49.7%), working in 69 countries. For diagnosis, Southern European countries used significantly more routine tests (eg, autoimmune testing, allergological tests, and parasitic investigation) than Northern European countries. Most respondents (60.3%) used a 2nd -generation antihistamine as first-line treatment of whom 64.8% updosed as a second line. Omalizumab was used as a second-line treatment by 1.7% and third line by 20.7% of respondents. Most clinicians (65%) follow EAACI/WAO/GA2LEN/EDF guidelines when diagnosing CU, and only 7.3% follow no specific guidelines. Some clinicians prefer to follow national guidelines (18.4%, mainly Northern European) or the AAAAI practice parameter (1.7%). Even though most members of the Pediatric Section of EAACI are familiar with the EAACI/WAO/GA2LEN/EDF guidelines, a significant number do not follow them. Also, the large variation in diagnosis and treatment strengthens the need to re-evaluate, update, and standardize guidelines on the diagnosis and management of CU in children.

The role of transcription factor FoxP3 as a predictor of acute and chronic urticaria in children

Objective: To study the transcription factor FoxP3 in children with acute and chronic spontaneous urticaria as a possible predictor of the severity and chronicity of urticaria.Materials and Methods: A total of 264 children of both sexes aged from 6 to 16 years old with diff erent variants of urticaria course were examined. Clinical methods of the study included the analysis of anamnestic data and an objective examination of the child with the determination of the severity of urticaria. Immunological methods of the study included the identifi cation of T-regulatory lymphocytes with the CD4+CD25+ Foxp3+CD45+immunophenotype.Results: A signifi cant decrease in the level of transcription factor FoxP3 was found in children with severe acute urticaria and chronic urticaria compared to the control group.Conclusion: Th e degree of reduction in the level of FoxP3 signifi cantly aff ected the likelihood of the development of a severe course of acute urticaria and possible chronization of the disease.

Современный подход к диагностике рецидивирующей и хронической крапивницы у детей

В статье обобщены сведения относительно диагностики рецидивирующей и хронической крапивницы у детей на основании анализа литературных источников с использованием бумажных носителей и электронных систем поиска информации PubMed, CyberLeninka, Web of Science, MedLine, The Cochrane Library. Приведены данные, касающиеся современной терминологии и классификации крапивницы, которая предусматривает разделение всех крапивниц на спонтанную и индуцированную. Особенностью данного обзора является то, что мы максимально обобщили сведения о диагностических методиках и оборудовании, которые используются в мире для диагностики физических крапивниц, и сгруппировали эти данные в виде таблицы. Очерчена проблема диагностики аутоиммунных форм крапивницы, показаны диагностические тесты, использование которых возможно в рутинной клиничеcкой практике. Приведен перечень заболеваний, с которыми необходимо провести дифференциальную диагностику с учетом конкретного случая. Особенностью этой статьи являются освещение данных относительно инфекций, являющихся причиной развития спонтанной крапивницы, группировка этой информации в единую таблицу, которая поможет врачу упростить представление о необходимом перечне диагностических интервенций. Приведены опросники и шкалы для установления степени тяжести и уровня контроля заболевания, а также интерпретация полученных результатов. В качестве вывода обобщены проблемы диагностики, которые являются направлением дальнейших научных исследований.

Clinical and anamnestic differences between acute and chronic urticaria in children

Objective: to study clinical, anamnestic, and laboratory parameters in children with acute and chronic urticaria.Materials and methods: fifty-five children were examined who were admitted to the pediatric department and day-time inpatient facility of the State Children’s Clinical Hospital No. 17 in Ufa in 2019. Two groups were formed: 44 patients with acute urticaria (Group 1) and 11 patients with chronic urticaria (Group 2). For the correct analysis of the hemogram and immunogram, 2 subgroups of patients with acute urticaria were formed: Group 1a – 13 children under 5 years old and Group 1b – 31 children over 5 years old.Results: acute urticaria was typical for young children (Z cor. = -2.14665; p = 0.031822). In children with acute urticaria under five years of age, there was a correlation (p &lt; 0.05) of age with low serum JgA levels (rs = 0.806380) and the incidence of gastropathology with JgM levels (rs = 0.872872); JgG (rs = 0.763763) and the number of blood leukocytes (rs = 0.692820). In children with acute urticaria over five years of age, a correlation was found between age and concomitant gastropathology (rs = 0.421569). Patients with chronic urticaria are characterized by eosinophilia (Z cor. = -2.96741; p = 0.003003) and a pathogenetically significant increase in the CEC level (Z cor. = 1.98537; p = 0.047104).Conclusion: the revealed differences should be taken into account during the examination and management of children with urticaria.

Retrospective Study of Clinico-Aetiological Factors of Chronic Urticaria Among Children Attending a Tertiary Care Paediatric Centre in Eastern Province of Sri Lanka.

Introduction: Chronic urticaria is one of the growing problems worldwide and the prevalence is increasing. Around 2% of children have been shown to be affected with chronic urticaria.Objectives: To evaluate demographic, clinical and aetiological factors related to chronic urticaria in children and to assess investigations and treatment.Method: A retrospective study was done from January 2018 to December 2019 on 40 children aged 1-14 years who presented with chronic urticaria to the paediatric clinic, University Paediatric Unit, Batticaloa Teaching Hospital. Detailed information including demographic factors, duration of illness, main reasons for clinic attendance, treatment received from the out-patient department, caregiver reported allergens, family history of atopy and complications such as secondary bacterial infection were retrieved from clinic-based records. Information regarding laboratory investigations was also retrieved. Data were analysed using SPSS version 19.0 (IBM Corp., Armonk, NY).Results: Forty children were available for the analysis. The most common age category was four to eight years and 25 (62.5%) were females. Seventy percent of children had urticaria for one or more years. Thirty-six (90%) children had a family history of allergies such as allergic rhinitis, eczema, food allergies, medication allergies and bronchial asthma. The common precipitating factors were foods in 12 (30%) cases and insect bites in 10 (25%) cases. The main reasons for seeking medical advice were severe itchiness in 40 (100%) and sleep disturbances in 24 (60%). Only a limited number of investigations had been performed and they included white cell counts (differential eosinophil counts) and thyroid functions. Almost all had normal thyroid functions whilst 45% had eosinophilia.Conclusions: The majority of children with chronic urticaria had symptoms for over the one-year duration and reported a family history of allergy. All children reported severe itchiness as the main symptom and sleep was disturbed in the majority. The common precipitating factors were food and insect bites.

Adjunct therapy with probiotics for chronic urticaria in children: randomised placebo-controlled trial

BackgroundsChronic urticaria is a common disorder of the skin, characterised by recurrent skin wheals and angioedema. Recent reports have shown that altered diversity and composition of the gut microbiota may lead to imbalances in immune regulation, a causal factor in the occurrence of chronic urticaria.ObjectiveThis study aimed to evaluate the efficacy of the Yimingjia® probiotic formula in the adjuvant treatment of chronic urticaria in children.MethodsWe enrolled 206 children with confirmed diagnoses of chronic urticaria and randomly assigned them to the treatment (n = 104) or placebo group (n = 102). The children in each group were treated with desloratadine dry suspension, and those in the treatment group also received Yimingjia®. Clinical efficacy was evaluated at 1, 2 and 4 weeks.ResultsClinical symptom scores did not differ significantly at weeks 1 and 2 (p > 0.05), but at 4 weeks, wheal size and attack frequency were significantly reduced in the treatment group (p = 0.049 and 0.03, respectively). The overall response rate (significant improvement + complete response) significantly differed between the treatment (80.8%) and placebo groups (62.5%) (χ2 = 4.20, p = 0.04).ConclusionAdjunct therapy with Yimingjia® was safe and effective at 4 weeks in the treatment of chronic urticaria in children. The study was registered under trial number NCT03328897.

Chronic urticaria in children - New insights from a large cohort.

Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. This retrospective study followed children up to 18years old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018, and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments, and outcomes were extracted from electronic medical records. Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4years, and 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25±15.2months. The urticaria in 208 children )83.2%) resolved within 24months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2%, and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population, increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.

Chronic urticaria in children under 15 years of age: Clinical experience beyond the clinical trials.

The aim of the study was to describe the clinical characteristics, management, and outcome of a series of children with chronic urticaria (CU). We retrospectively studied children aged <15years diagnosed with CU in a tertiary teaching hospital in Palma de Mallorca, Spain, between January 2014 and March 2019. CU was defined as persistence of symptoms of wheals, with or without angioedema, for >6weeks. Twenty-nine patients (17 girls, mean age 8years) were included. Family history of atopy was found in 31% of the cases. In 41.3% of patients, episodes of CU were associated with angioedema. Physical triggers were found in 34.5% of the cases. Most episodes of CU were successfully managed with the recommended (60.7%) or double the recommended dose (17.2%) of H1-antihistamines. Quadruple the recommended dose of H1 antihistamines was used in six patients, five of whom were finally treated with off-label omalizumab. Treatment with anti-leukotrienes was needed in one patient. Associated thyroiditis was diagnosed in one patient, which was controlled with levothyroxine. Pediatric CU showed features similar to CU in adulthood, including a greater predominance in females and frequent association with personal or family history of atopy. Adult guidelines for the treatment of CU are currently extrapolated to the pediatric population. Specific tools for the assessment of disease activity and impairment of quality of life in pediatric CU are needed for use in prospective studies aimed to define treatment strategies for children with CU.

Chronic Urticaria in Children: an Update on Diagnosis and Treatment.

Both adults and children are frequently affected by symptoms of itchy urticarial lesions that cause considerable distress and impact nearly all their daily activities. A comprehensive history is critical to identify the etiology in patients who have chronic spontaneous urticaria (CSU) (those with symptoms for > 6 weeks) and is more important than extensive laboratory serum tests. Unfortunately, most of the current treatment guidelines have been based on data from adult studies since there is rare data on children. These treatment algorithms have been subsequently used to extrapolate treatments for children. Current treatment regiments do not achieve complete success in all patients, neither adults nor children. As the pathophysiology of chronic urticaria slowly becomes defined, novel therapies are being tested which target these individual molecular pathways to treat those that continue to experience symptoms. Future studies are required to establish the natural history, risks/benefits and efficacy of current medications, and biologics used to treat CSU in children.

Clinical Observation on the Effect of Chinese Medicine Five-Color Therapy on the Treatment of Children with Chronic Urticaria

Objective: To analyze the clinical treatment effect of traditional Chinese medicine five-color therapy on chronic urticaria in children. Methods: The income data target of this article is 80 children with chronic urticaria. The grouping method is a randomized method with 40 children in each group. The experimental group was treated with five-color treatment of traditional Chinese medicine, and the control group was treated with western medicine. The incidence, treatment and recurrence of adverse reactions in children with chronic urticaria were compared between the two groups. Results: Showed total effective rate of children with chronic urticaria in the experimental group was compared with the control group, P&lt;0.05, the data showed statistical significance. Conclusion: Stated use of TCM five-color therapy in the treatment of children with chronic urticaria can significantly improve safety.

Chronic urticaria in children can be controlled effectively with updosing second-generation antihistamines

Chronic urticaria in children can be controlled effectively with updosing second-generation antihistamines

Clinico-epidemiological features of chronic urticaria in children: A retrospective analysis of 296 children from a tertiary care institute in Northern India.

Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered, however, epidemiologic data on pediatric urticaria are limited. The objective of this study was to study the clinico-epidemiological profile of children with chronic urticaria. A retrospective study including children less than 14 years with chronic urticaria was conducted from January 2010 to December 2015. Detailed history, clinical examination, investigation results, treatment taken, and follow-up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders. Two hundred and ninety-six children (166 boys, 130 girls; mean age, 11.3 years) with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 57.1% (169) children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in 48 (16.2%) patients; Antinuclear antibody was negative in all patients, raised serum IgE in 20/48 (41.6%), positive autologous serum skin test in 32/48 (66.6%) and raised anti-TPO titre in 10/48 (20.8%) children. A diagnosis of chronic spontaneous urticaria was made in 245 (82.77%) children, chronic dermographic urticaria in 35 (11.82%), cholinergic urticaria and drug-induced urticaria in 5 (1.69%) each, aquagenic urticaria in 4 (1.35%) and cold-induced urticaria in 2 (0.68%) children. Two hundred and fifteen (72.6%) children responded to nonsedating antihistamines alone, 61 (20.6%) required addition of a sedating antihistamine, 7 (0.02%) required addition of montelukast, 3 (0.01%) ranitidine and 10 (20.8%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long-term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months. The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated. Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long-term antihistamines.

Medication used to control symptoms of chronic urticaria in children.

A number of guidelines for management of CU were established based on evidences in adults. In children, the response to CU treatment was not widely studied. To investigate the medications used to control symptoms of CU in children and to identify factors associated with time to control CU. Medical records of children with controlled CU visiting Allergy clinic, Siriraj hospital were examined. Controlled CU was defined as no urticarial lesion while the patients used the same daily medications over 8-12 weeks. Demographic data, clinical progression of CU and medications used in each visit were recorded. The steps of CU management were categorized into groups according to the Joint Task Force Practice Parameter (JTFPP) in CU 2014 guideline. One hundred children (48 males) with 'controlled CU' were recruited. The median age at first visit was 8 (5.4010.60) years. Thirty-two percent of the patients had associated angioedema. The median time to control CU was 9 (6.9011.10) months. Forty-four percent of the patients control CU with standard dose of second generation antihistamine (step 1) and the rest of the patients used the medications in step 2 to control CU. None of the patients needed systemic corticosteroid or immunomodulatory agent. The steps of treatment, angioedema and associated conditions related to CU did not affect time to control. Only up to a half of pediatric patients with CU had a favorable response to standard dose of second generation antihistamine. The rest required step 2 treatment of JTFPP to control their symptoms.