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A stepwise approach in the management of chronic spontaneous urticaria in children
Xin Hui Magdeline Lee1, Lin Xin Ong2, Jing Yi Vanessa Cheong1
1Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
Insights
A new weight and age-based algorithm effectively manages chronic spontaneous urticaria (CSU) in children. This approach improves symptom control and safety, offering a systematic method for pediatric CSU management.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Pharmacology
Background:
- Limited literature exists on managing chronic urticaria in children.
- Current treatment algorithms are often adapted from adult studies.
- Pediatric chronic spontaneous urticaria (CSU) requires specific management guidelines.
Purpose of the Study:
- To evaluate a weight and age-based algorithm for antihistamine use in pediatric CSU.
- To identify factors predicting symptom control and time to control in children with CSU.
- To establish a systematic approach for managing pediatric CSU.
Main Methods:
- A multidisciplinary workgroup developed a stepwise treatment algorithm for pediatric CSU.
- An observational, prospective study included sequential patients presenting to a pediatric allergy service.
- Data collection focused on patient demographics, medical history, and treatment outcomes.
Main Results:
- 96.9% of 98 recruited pediatric patients achieved symptom control for CSU.
- Cetirizine was effective in 91.8% of controlled patients.
- Fifty percent of patients required step 2 or higher treatment, with younger children (2-6 years) more represented in these steps.
Conclusions:
- A proposed weight- and age-based titration algorithm offers a systematic approach to pediatric CSU management.
- This algorithm may enhance the safety and efficacy of antihistamine treatment in children.
- The stepwise approach facilitates systematic review for physicians managing pediatric CSU.
Background:
There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies.
Objective:
Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children.
Methods:
A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study.
Results:
Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control.
Conclusion:
We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.
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