Chronic urticaria treatment challenges in children

This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group.

Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents).

According to the current guideline's algorithm, the treatment of CU involves using high doses of antihistamines when there is no response with the licensed dosage. The effectiveness of this increase in children has been demonstrated with control rates ranging from 35% to 92%, with few studies addressing safety profiles. Omalizumab is approved for children over 12 years of age as a second step in the algorithm. Although more studies with children are needed to assess its effectiveness and safety, some data show complete control of symptoms in more than 80% of pediatric cases with no adverse effects, including in children under 12 years. When monitored closely, cyclosporine showed a good response rate in pediatric CU with few adverse events. Also, PROMs validated for this age can be helpful in clinical decisions, such as Urticaria Activity Score summed over 7 days, Urticaria Control Test, and Chronic Urticaria Quality of Life Questionnaire.

Collaborative studies are necessary to generate stronger evidence to support the guideline recommendations for children. The existing data indicate that these drugs are safe and effective for treatment when dose adjustments are made.