Is Routine Skin Prick Testing Essential in Managing Pediatric Chronic Urticaria?

Chronic urticaria (CU) in children, persisting beyond six weeks, is less common than acute urticaria, with a prevalence of 0.1%-0.3%. CU is classified into chronic idiopathic urticaria (CIU) and chronic inducible urticaria (CIndU), with CIU having an often unknown etiology, whereas CIndU is triggered by physical stimuli. Our study aims to explore the clinical and demographic characteristics, laboratory results, and possible etiological factors in children diagnosed with CU, and to assess the necessity of aeroallergen skin prick tests (SPTs) in these patients. The study evaluated the medical records of 242 children with CU, treated at the Pediatric Allergy-Immunology Clinic of Prof. Dr. Cemil Taşcıoğlu City Hospital from January 2018 to January 2024. Data on age, gender, presence of angioedema, dermatographism, concomitant allergic diseases, family history of atopy, infection status, urticaria duration, SPT results, and laboratory tests were collected and analyzed. Results showed that 48.3% of patients were females and 51.7% were males, with an average age of 12.8 years and an average onset age of 9.9 years. Angioedema was present in 15.7% of patients, dermatographism in 17.8%, concomitant allergic diseases in 24%, and a family history of atopy in 14.5%. Infections were documented in 10.8% of patients, with urinary tract infections, Helicobacter pylori (H. pylori) infections, and dental infections identified. Our study found no significant differences in clinical features, treatment requirements, or response to treatments between patients with positive and negative SPT results. Laboratory parameters such as eosinophilia, total Immunoglobulin E (IgE), and thyroid function tests also showed no significant differences. These findings suggest that routine SPTs for the management of CU in children will only be useful if IgE-mediated allergic comorbidities are suspected but may not be necessary in other cases, prompting a reevaluation of their use in clinical practice to seek more cost-effective diagnostic methods.