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An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI
Stefania Arasi1, Helena Pite2,3, Burcin Beken4
1Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Pediatric chronic urticaria (CU) management shows variability in guideline adherence and testing. Improved access to diagnostic tools and education are needed for evidence-based care in children.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Clinical Practice Guidelines
Background:
- The EAACI Task Force focused on identifying disparities in diagnosing and managing chronic urticaria (CU) in pediatric patients aged 0-18 years.
- Understanding these differences is crucial for standardizing care and improving outcomes for children with CU.
Purpose of the Study:
- To explore current diagnostic and management practices for childhood chronic urticaria (CU) among healthcare professionals.
- To identify challenges and variations in applying evidence-based guidelines for CU in pediatric populations.
Main Methods:
- An online survey with 41 multiple-choice questions was distributed to EAACI members regarding their CU management practices.
- The survey targeted pediatric allergists and other specialists involved in pediatric allergy care.
Main Results:
- 161 participants from 55 countries responded, with most (74.5%) being pediatric allergists.
- While 68.3% use EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines, 10.6% use no guidelines. Common diagnostic tests include CBC, thyroid profile, IgE, and thyroid antibodies.
- Less than 20% routinely test for chronic inducible urticaria. Treatment escalation often involves increased antihistamine dosage; omalizumab use varies by age, and ciclosporin or corticosteroids are used for non-responders.
Conclusions:
- Challenges persist in implementing evidence-based guidelines for CU diagnosis and treatment in children.
- There is a need for increased availability of specific diagnostic tools and enhanced education and research in pediatric CU management.
Background:
The EAACI Task Force entitled "Improving Chronic Urticaria (CU) Management in Pediatrics" aimed to explore the differences in the diagnostic and management practices for CU in children (0-18 years).
Methods:
An online clinical survey including 41 multiple choice questions on current practices for the management of childhood CU was disseminated among EAACI members.
Results:
The survey was circulated to 50,472 contacts via mass email and to 2343 contacts via EAACI social media channels and answered by 161 participants from 55 countries. Most respondents were pediatric allergists (74.5%). While 68.3% of the respondents stated that they use the EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline, 10.6% declared that they do not use any guideline. Full blood count (83.3%), thyroid profile (64.6%), IgE (62.7%), thyroid antibodies (62.1%), C-reactive protein (59%), and antinuclear antibodies (ANA) or other antibodies (50.9%) were the most commonly used routine tests when diagnosing CU patients. Less than 20% of the respondents said they test their patients routinely for chronic induced urticaria when clinically suspected. Reasons for not testing at all were a lack of needed equipment or not knowing how to perform the test. In patients who do not respond to second-generation antihistamine standard dose, two to four-times increased dosage was the preferred step, independently of the child's age. Many participants do not prescribe omalizumab in children aged <5 years (77.6%), 6-11 years (45%), and adolescents (24.7%). In children who do not respond to omalizumab, almost half of the prescribing clinicians stated that they prefer oral ciclosporin-A, and 20% use oral corticosteroids.
Conclusions:
Some challenges to the effective use of evidence-based CU guidelines persist around basic testing in the diagnostic workup and pharmacological treatment in children. This study suggests the need for broader availability of specific testing tools and for further education and research in this field.
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