Dermatology| September 01 2003 Does Childhood Chronic Urticaria Indicate an Underlying Thyroid Disorder? AAP Grand Rounds (2003) 10 (3): 36–37. https://doi.org/10.1542/gr.10-3-36 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Does Childhood Chronic Urticaria Indicate an Underlying Thyroid Disorder?. AAP Grand Rounds September 2003; 10 (3): 36–37. https://doi.org/10.1542/gr.10-3-36 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chronic urticaria, thyroid diseases Source: Levy I, Segal N, Weintrob N, et al. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003;88:517–519. Chronic urticaria has been defined as the daily occurrence of wheals for greater than 6 weeks.1 The literature regarding childhood chronic urticaria and its autoimmune basis is scant. In adult series, 14–33% of patients have been shown to have autoimmune thyroid disease.2 In this case series, Israeli investigators evaluated children referred to an allergy clinic between 1994 and 2001 for chronic urticaria lasting ≥6 weeks. Patients were included in the study if they had suffered from urticaria. Affected children were comprehensively evaluated for abnormalities in blood chemistry, complete blood count, rheumatologic profiles (antinuclear antibodies, complement levels, erythrocyte sedimentation rates), and tests for possible bacterial and viral infections; skin prick testing for food allergens; testing for cold and physical urticaria; and special autoimmune studies (free thryoxine, thyroidstimulating hormone [TSH], antithryoid peroxidase [anti-TPO] antibodies, antithyroglobulin [anti-Tg] antibodies, and for those with a positive family history of diabetes, anti-islet cell antibodies). Of the 187 children identified (age 6–18 years, male: female ratio 0.92), 8 patients demonstrated abnormal thyroid antibody profiles. Four patients had isolated anti-TPO antibodies, 2 only anti-Tg antibodies, and 2 patients had both autoantibodies. Although 2 had elevated TSH levels, all patients had normal thyroxine values. One patient had known Hashimoto’s thyroiditis with anti-TPO antibodies, but with supplemental medication had normal thyroxine and TSH levels. This patient developed chronic urticaria 3 years after the onset of the thryoiditis. The key observations from the study were: The authors recommend periodic screening of children with chronic urticaria for thyroid autoimmunity and hypothyroidism. The etiology of chronic urticaria is often elusive, with fewer than 25% of cases having identified causes.3 Childhood chronic urticaria has been associated with autoimmune disorders including celiac disease, juvenile rheumatoid arthritis, type I diabetes mellitus, and thyroid autoimmunity.4,5 As with adults, additional cases in children have recently been linked to activation of dermal mast cells by autoantibodies to the high-affinity IgE receptor (anti-FcεRI).1 Although evidence of thyroid autoimmunity was seen in 4.3% of the study population, caution regarding the authors’ conclusion should be exercised because no age-matched control group was provided for comparison. Prior studies cited by the authors report rates of thyroid autoimmunity of 0.35% to 1.6% in 3 very different populations of children who may or may not be directly comparable to their population.6–,8 A recent systematic review evaluated the utility of laboratory testing of adults with chronic urticaria and found little evidence to support routine testing unless patients have clinical evidence of comorbidity.9 Given that hypothyroidism in children with chronic urticaria is rare, it is not altogether clear that routine testing for thyroid autoantibodies is appropriate unless the patient has evidence of a goiter, other clinical manifestations of hypothyroidism, or abnormalities in TSH or thyroxine levels. You do not currently have access to this content.