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Can urticaria severity be used as a biomarker for transition from acute to chronic urticaria?
Güler Yıldırım1, Deniz Ozceker1, Alper Kaçar2
1Department of Pediatric Allergy and Immunology, Cemil Taşçıoğlu City Hospital, Istanbul, Turkey.
Insights
High urticaria activity scores in the first week and the need for additional therapies predict the progression of acute urticaria (AU) to chronic urticaria (CU) in children. Early intervention strategies can help manage AU and reduce the risk of chronicity.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Clinical Medicine
Background:
- Acute urticaria (AU) can spontaneously resolve but may progress to chronic urticaria (CSU).
- Identifying risk factors for AU progression to CSU in children is crucial for timely management.
- Understanding these factors aids in developing early intervention strategies.
Purpose of the Study:
- To investigate the clinical and laboratory factors associated with the progression of AU to CSU in pediatric patients.
- To identify predictors of chronicity in acute urticaria cases.
Main Methods:
- A prospective study analyzed 155 pediatric patients diagnosed with AU.
- Logistic regression was used to analyze factors influencing the transition from AU to CSU.
- Urticaria Activity Score (UAS7), eosinophil levels, and treatment intensity were assessed.
Main Results:
- Approximately 9% of pediatric AU patients progressed to CSU.
- Higher first-week Urticaria Activity Scores (UAS7) were significantly associated with progression to CSU (p < .001).
- Elevated eosinophil levels (p = .006) and the need for intensive treatments (p = .038) were identified as significant risk factors.
Conclusions:
- The severity of urticaria in the first week (UAS7) is a key predictor of chronicity.
- The requirement for additional therapies also indicates an increased risk of developing CSU.
- These findings support the development of early management strategies for acute urticaria to prevent chronicity.
Background:
Acute urticaria usually resolves spontaneously; however, in some cases, it may progress to CSU. We aimed to investigate the underlying factors of AU in children and the clinical and laboratory factors affecting the progression of AU to CSU.
Methods:
A prospective analysis was performed in 155 patients under 18 years of age who were diagnosed with AU and treated in our hospital. Factors affecting the transition from acute urticaria to chronic urticaria were analyzed using logistic regression.
Results:
Progression of AU to CSU was observed in 9% of patients. The urticaria activity scores of the first week (UAS7) in patients who progressed to CSU were significantly higher than those of patients who did not develop CSU (UAS7: Median 14.5, Min-Max 6-32, p < .001). Additionally, elevated eosinophil levels (Median 3.6%, Min-Max 0-11, p = .006) and the need for more intensive treatments, including parenteral steroids, antihistamines, and additional therapies (42.9% of CU patients, p = .038), were identified as significant risk factors for progression to CSU. In univariate regression analysis, the UAS7 score was found to be statistically significant (OR: 1.131, 95% CI: 1.056-1.212, p < .001). In multivariate analysis, we found that high UAS7 scores (OR: 1.169, 95% CI: 1.072-1.275, p < .001) and the need for combined treatment with additional therapies (OR: 8.240, 95% CI: 1.007-67.441, p = .049) were independent risk factors for progression from AU urticaria to CU.
Conclusion:
We found that the severity of urticaria during the first week and the need for additional therapies are important indicators in predicting the risk of chronicity. These findings may help to develop strategies to effectively manage AU in the early stages.
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