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Chronic urticaria in childhood: natural course and etiology
Insights
Chronic urticaria in children often has an unknown cause but a good outlook. While most cases resolve, infections or autoimmune conditions should be considered.
Area of Science:
- Pediatrics
- Immunology
- Dermatology
Background:
- Urticaria, commonly known as hives, affects a significant number of children.
- Chronic urticaria, defined as lasting longer than six weeks, presents diagnostic challenges in pediatric populations.
Purpose of the Study:
- To investigate the etiology and prognosis of chronic urticaria in children.
- To identify potential triggers and underlying conditions associated with persistent hives in pediatric patients.
Main Methods:
- Retrospective analysis of 94 pediatric patients diagnosed with chronic urticaria.
- Evaluation of patient data including demographics, suspected causes, and long-term follow-up outcomes.
Main Results:
- The cause of chronic urticaria was identified or suspected in only 15% of cases, including cold urticaria, infections, food allergies, juvenile rheumatoid arthritis, and autoimmune markers.
- Over a year of follow-up for 52 patients showed a median symptom duration of 16 months.
- While 58% of children achieved symptom remission for at least six months, 42% experienced recurrent symptoms without developing serious underlying illnesses.
Conclusions:
- The etiology of chronic urticaria in childhood frequently remains undetermined.
- The prognosis for pediatric chronic urticaria is generally favorable, with most children experiencing symptom resolution or manageable recurrent episodes.
- It is crucial to consider underlying infections or autoimmune diseases in the differential diagnosis of chronic urticaria in children.
Abstract:
We retrospectively studied 94 children with urticaria longer than six weeks in duration. The disease was equally distributed among the sexes and the following age subgroups (0-3.9 years, 4.0-7.9 years, 8.0-11.9 years and 12.0-15.9 years). A cause of the urticaria was identified or suspected in 15 of the patients. These included eight patients with cold urticaria, two with infection (hepatitis, sinusitis), two with food allergy, one patient with juvenile rheumatoid arthritis, one with arthralgia associated with a positive ANA and one with a low level of total hemolytic complement (CH50). Follow-up of a year of more on 52 patients revealed a median duration of urticarial symptoms of 16.0 months, with 58% of children becoming symptom free for six months or more, whereas the remaining 42% continued to have recurrent symptoms but without the development of an underlying serious illness. Results of the present study indicate that the etiology of chronic urticaria in childhood remains mostly undetermined but that the prognosis is generally favorable. However, one must consider an underlying infection or autoimmune disease as a potential etiology.