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Management of urticaria and angioedema in children: new trends
1Department of Pediatrics, Division of Pediatric Dermatology, Erasmus MC, University Medical Center, KinderHaven, Havenziekenhuis. a.oranje@inter.nl.net
Insights
Childhood urticaria, often acute and idiopathic or physical, requires careful history taking. First-line treatment involves oral antihistamines, with dosage adjustments considered for persistent cases.
Area of Science:
- Pediatrics
- Allergology
- Immunology
Background:
- Urticaria is a prevalent condition in childhood.
- Accurate diagnosis relies on detailed patient history and adherence to consensus guidelines (e.g., EAACI/GALEN/EDF).
- A new updated consensus is forthcoming, refining classification and management strategies.
Purpose of the Study:
- To outline the current understanding and management of childhood urticaria.
- To highlight the classification of urticaria, including spontaneous, physical, and other specific disorders.
- To provide guidance on the initial treatment approach for pediatric urticaria.
Main Methods:
- Review of existing consensus guidelines for urticaria definition, classification, diagnosis, and management.
- Analysis of common urticaria types in children, distinguishing between acute and chronic forms.
- Emphasis on identifying and addressing potential causes and triggers.
Main Results:
- Childhood urticaria commonly presents as acute idiopathic or physical urticaria.
- Urticarial flares in atopic dermatitis may indicate food allergy in young children.
- Oral non-sedating H1 antihistamines are the recommended first-line therapy.
Conclusions:
- Management principles for childhood urticaria largely mirror adult protocols, with specific considerations for pediatric cases.
- Identifying and eliminating causative factors is crucial, though challenging in chronic urticaria.
- Escalation of antihistamine dosage or alternative therapies may be necessary for refractory cases.
Abstract:
Urticaria in childhood is a common problem. History of development of urticaria should be carefully taken from a written history/information list. For urticaria, the EAACI/GALEN/EDF consensus guidelines on definition, classification, diagnosis and management of urticaria should be considered. Soon an updated version of a new consensus will appear. The new classification of urticaria includes 3 main groups: spontaneous or idiopathic urticaria (divided in acute <6 weeks and chronic urticaria ≥6 weeks), physical urticaria (cold contact urticaria, delayed pressure urticaria) and other urticaria disorders such as aquagenic urticaria. In general aspects, there is no difference between children and adults, except some details. In children most urticaria are acute idiopathic or physical of character. Also, urticarial flares in atopic dermatitis in young children are common as manifestation of food allergy First step of treatment is directed to the cause (that is difficult in chronic urticaria) and triggering factors. The currently recommended first line treatment is application of oral nonsedating H1 antihistamines. If needed, the dosage of antihistamines should be up to two-fold (in adults four-fold), although evidence is lacking for this, whereas alternative treatment should be reserved as add-on therapy for unresponsive patients.
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