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Prevention of acute urticaria in young children with atopic dermatitis
1Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada, R3A 1R9.
Insights
Long-term cetirizine treatment effectively prevents acute urticaria in young children with atopic dermatitis. The protective effect of this H(1)-receptor antagonist diminishes upon cessation of treatment.
Area of Science:
- Pediatric Dermatology
- Allergy and Immunology
- Clinical Trials
Background:
- Lack of prospective, randomized, double-blind, placebo-controlled studies on urticaria prevention in children.
- Atopic dermatitis is common in young children, often accompanied by other allergic conditions.
Purpose of the Study:
- To evaluate the efficacy of long-term cetirizine treatment for preventing urticaria in young children diagnosed with atopic dermatitis.
- To assess the duration of the protective effect of cetirizine after treatment cessation.
Main Methods:
- Prospective, double-blind, parallel-group randomized controlled trial (Early Treatment of the Atopic Child study).
- 817 children (12-24 months) with atopic dermatitis received either cetirizine (0.25 mg/kg twice daily) or placebo for 18 months, followed by 6 months of observation.
- Caregiver diaries prospectively recorded symptoms, including hives, daily or weekly, validated by investigators.
Main Results:
- Acute urticaria incidence was significantly lower in the cetirizine group (5.8%) compared to placebo (16.2%) (P <.001).
- The preventive effect of cetirizine was lost after treatment discontinuation.
- Urticaria episodes were frequently linked to infections, food ingestion, or direct skin contact.
Conclusions:
- Acute urticaria is prevalent in toddlers with atopic dermatitis.
- Cetirizine demonstrates significant preventive efficacy for acute urticaria in this high-risk pediatric population.
- Continuous treatment is necessary to maintain the protective benefits of cetirizine against urticaria.
Background:
There are no published prospective, randomized, double-blind, placebo-controlled studies of urticaria prevention in children.
Objective:
Our objective was to study the effect of long-term treatment with the H(1)-receptor antagonist cetirizine in the prevention of urticaria in young children with atopic dermatitis.
Methods:
In the prospective, double-blind, parallel-group Early Treatment of the Atopic Child study, 817 children with atopic dermatitis who were 12 to 24 months of age at study entry were randomized to receive either cetirizine, 0.25 mg/kg, or matching placebo twice daily for 18 months and to be followed up for an additional 6 months, during which time the study medication code remained unbroken. During both these double-blind phases of the study, for a total of 24 months, caregivers prospectively recorded all symptoms and events, including hives, in a diary on a weekly basis when the child was well and on a daily basis when a symptom or event was observed. The diaries were reviewed and validated with the investigators at each regularly scheduled study visit.
Results:
Acute urticaria occurred in 16.2% of the placebo-treated children and in 5.8% of the children treated with cetirizine (P <.001). The protective effect of cetirizine disappeared when treatment was stopped. In the study population as a whole, urticaria episodes were most commonly associated with intercurrent infection or with food ingestion or direct skin contact.
Conclusion:
Acute urticaria is common in toddlers with atopic dermatitis and can be prevented with cetirizine in this high-risk population.
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