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Published on: December 15, 2011
High prevalence of autoimmune urticaria in children with chronic urticaria
Luigia Brunetti1, Ruggiero Francavilla, Vito L Miniello
1Department of Biomedicina dell'Età Evolutiva, University of Bari, Italy. l.brunetti@pediatria3.uniba.it
Insights
Autoimmune urticaria (AU) affects up to 30% of children with chronic urticaria (CU), similar to adults. Screening for AU significantly reduces the diagnosis of idiopathic CU in children.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Immunology
Background:
- The cause of chronic urticaria (CU) in children is often unknown.
- Autoimmune urticaria (AU) accounts for about 40% of CU cases in adults, but data in children are lacking.
Purpose of the Study:
- To determine the prevalence of autoimmune urticaria (AU) in children with chronic urticaria (CU).
- To identify potential risk factors for AU in pediatric CU patients.
Main Methods:
- Evaluated 93 children with CU for AU using autologous serum skin test (ASST) and basophil histamine release (HR-urticaria test).
- Excluded other known causes of CU.
- ASST and HR-urticaria tests were used to assess for autoantibodies.
Main Results:
- Autoimmune urticaria (AU) was diagnosed in 31% of children with chronic urticaria (CU).
- The autologous serum skin test (ASST) demonstrated high sensitivity (78%) and specificity (85%) for AU diagnosis.
- Screening for AU reduced the rate of idiopathic CU from 52% to 20%.
Conclusions:
- Children can produce autoantibodies against IgE or IgE receptors, similar to adults, indicating AU is common in pediatric CU.
- Identifying AU in children is crucial for accurate diagnosis and management, reducing the idiopathic CU rate.
Background:
The etiology of chronic urticaria (CU) in childhood often remains unrecognized. Recently, in adults it has been shown that approximately 40% of patients with CU have autoimmune urticaria (AU); however, no data are available in children.
Objective:
To determine the prevalence and possible risk factors for AU in children with CU.
Methods:
Ninety-three consecutive children (52 male; median age, 7.8 years) with CU were evaluated for AU by means of autologous serum skin test (ASST) in all and serum-induced basophil histamine release (HR-urticaria test) in 52. All other known causes of CU were excluded as appropriate.
Results:
A cause for CU was identified in 44 children (47%), whereas 49 (53%) remained idiopathic. ASST and HR-urticaria test had positive results in 22 of 49 (45%) and in 16 of 31 (52%) children with idiopathic CU compared with 1 of 44 (2%) and 5 of 21 (24%) with CU of a known cause, respectively ( P <.00001; P=.09). Sensitivity, specificity, and positive and negative predictive values of the ASST for diagnosing AU are 78%, 85%, 74%, and 88%. The prevalence of AU in childhood is 31% (15/52; 95% CI, 24%-51%). None of the variables studied were predictive for development of AU.
Conclusion:
Our results demonstrate for the first time that children have the same ability as adults to produce functionally active autoantibodies directed against IgE or IgE receptor and that AU occurs in children in as many as 30% of cases. The addition of screening for AU dramatically decreases the rate of the idiopathic form from 52% to 20%.
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