Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Characteristics of Chronic Urticaria
3.2. Underlying Causes
3.3. Drug Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Zuberbier, T.; Aberer, W.; Asero, R.; Abdul Latiff, A.H.; Baker, D.; Ballmer-Weber, B.; Bernstein, J.A.; Bindslev-Jensen, C.; Brzoza, Z.; Buense Bedrikow, R.; et al. Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. Allergy 2018, 73, 1393–1414. [Google Scholar] [CrossRef] [PubMed]
- Caffarelli, C.; Paravati, F.; El Hachem, M.; Duse, M.; Bergamini, M.; Simeone, G.; Barbagallo, M.; Bernardini, R.; Bottau, P.; Bugliaro, F.; et al. Management of chronic urticaria in children: A clinical guideline. Ital. J. Pediatr. 2019, 45, 101. [Google Scholar] [CrossRef] [PubMed]
- Magerl, M.; Altrichter, S.; Borzova, E.; Giménez-Arnau, A.; Grattan, C.E.H.; Lawlor, F.; Mathelier-Fusade, P.; Meshkova, R.Y.; Zuberbier, T.; Metz, M.; et al. The Definition, Diagnostic Testing, and Management of Chronic Inducible Urticarias—The EAACI/GA(2) LEN/EDF/UNEV. Consensus Recommendations 2016 Update and Revision. Allergy 2016, 71, 780–802. [Google Scholar] [CrossRef] [PubMed]
- Levy, Y.; Segal, N.; Weintrob, N.; Danon, Y.L. Chronic urticaria: Association with thyroid autoimmunity. Arch. Dis. Child. 2003, 88, 517–519. [Google Scholar] [CrossRef] [PubMed]
- Caminiti, L.; Passalacqua, G.; Magazzù, G.; Comisi, F.; Vita, D.; Barberio, G.; Sferlazzas, C.; Pajno, G.B. Chronic urticaria and associated coeliac disease in children: A case-control study. Pediatr. Allergy Immunol. 2005, 16, 428–432. [Google Scholar] [CrossRef] [PubMed]
- Harris, A.; Twarog, F.J.; Geha, R.S. Chronic urticaria in childhood: Natural course and etiology. Ann. Allergy 1983, 51, 161–165. [Google Scholar] [PubMed]
- Netchiporouk, E.; Sasseville, D.; Moreau, L.; Habel, Y.; Rahme, E.; Ben-Shoshan, M. Evaluating comorbidities, natural history, and predictors of early resolution in a cohort of children with chronic urticaria. JAMA Dermatol. 2017, 153, 1236–1242. [Google Scholar] [CrossRef] [PubMed]
- Volonakis, M.; Katsarou-Katsari, A.; Stratigos, J. Etiologic factors in childhood chronic urticaria. Ann. Allergy 1992, 69, 61–65. [Google Scholar] [PubMed]
- Khakoo, G.; Sofianou-Katsoulis, A.; Perkin, M.R.; Lack, G. Clinical features and natural history of physical urticaria in children. Pediatr. Allergy Immunol. 2008, 19, 363–366. [Google Scholar] [CrossRef]
- Dice, J.P. Physical urticaria. Immunol. Allergy Clin. N. Am. 2004, 24, 225–246. [Google Scholar] [CrossRef]
- Jirapongsananuruk, O.; Pongpreuksa, S.; Sangacharoenkit, P.; Visitsunthorn, N.; Vichyanond, P. Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients. Pediatr. Allergy Immunol. 2010, 21, 508–514. [Google Scholar] [CrossRef] [PubMed]
- Shalom, G.; Magen, E.; Dreiher, J.; Freud, T.; Bogen, B.; Comaneshter, D.; Vardy, D.A.; Khoury, R.; Agmon-Levin, N.; Cohen, A.D. Chronic urticaria and atopic disorders: A cross-sectional study of 11,271 patients. Br. J. Dermatol. 2017, 177, e96–e97. [Google Scholar] [CrossRef] [PubMed]
- Kozel, M.M.; Mekkes, J.R.; Bossuyt, P.M.; Bos, J.D. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch. Dermatol. 1998, 134, 1575–1580. [Google Scholar] [CrossRef] [PubMed]
- Lang, D.M.; Hsieh, F.H.; Bernstein, J.A. Contemporary approaches to the diagnosis and management of physical urticaria. Ann. Allergy Asthma Immunol. 2013, 111, 235–241. [Google Scholar] [CrossRef]
- Eser, I.; Yologlu, N.; Baydemir, C.; Aydogan, M. The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study. Allergol. Immunopathol. 2016, 44, 537–541. [Google Scholar] [CrossRef]
- Sharma, M.; Bennett, C.; Cohen, S.N.; Carter, B. H1-Antihistamines for chronic spontaneous urticaria. Cochrane Database Syst. Rev. 2014, 2014, CD006137. [Google Scholar] [CrossRef] [PubMed]
- Saini, S.; Rosen, K.E.; Hsieh, H.-J.; Wong, D.A.; Conner, E.; Kaplan, A.; Spector, S.; Maurer, M. a randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with h1-antihistamine-refractory chronic idiopathic urticaria. J. Allergy Clin. Immunol. 2011, 128, 567–573.e1. [Google Scholar] [CrossRef] [PubMed]
- Maurer, M.; Rosén, K.; Hsieh, H.-J.; Saini, S.; Grattan, C.; Gimenéz-Arnau, A.; Agarwal, S.; Doyle, R.; Canvin, J.; Kaplan, A.; et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N. Engl. J. Med. 2013, 368, 924–935. [Google Scholar] [CrossRef]
- Asero, R.; Tedeschi, A. usefulness of a short course of oral prednisone in antihistamine-resistant chronic urticaria: A retrospective analysis. J. Investig. Allergol. Clin. Immunol. 2010, 20, 386–390. [Google Scholar]
- Di Lorenzo, G.; Pacor, M.L.; Mansueto, P.; Esposito-Pellitteri, M.; Ditta, V.; Lo Bianco, C.; Leto-Barone, M.S.; Di Fede, G.; Rini, G.B. Is there a role for antileukotrienes in urticaria? Clin. Exp. Dermatol. 2006, 31, 327–334. [Google Scholar] [CrossRef]
- Nettis, E.; Colanardi, M.C.; Paradiso, M.T.; Ferrannini, A. desloratadine in combination with montelukast in the treatment of chronic urticaria: A randomized, double-blind, placebo-controlled study. Clin. Exp. Allergy 2004, 34, 1401–1407. [Google Scholar] [CrossRef]
- Sabroe, R.A.; Grattan, C.E.; Francis, D.M.; Barr, R.M.; Kobza Black, A.; Greaves, M.W. The autologous serum skin test: A screening test for autoantibodies in chronic idiopathic urticaria. Br. J. Dermatol. 1999, 140, 446–452. [Google Scholar] [CrossRef] [PubMed]
- Özen, B.; Sancakli, O.; Duman Senol, H.; Ozdogru, E.E.; Tuncel, T. An evaluation of the factors affecting the clinical and laboratory findings, prognosis, and treatment response in children with chronic urticaria. Dermatol. Ther. 2022, 35, e15261. [Google Scholar] [CrossRef] [PubMed]
- Caffarelli, C.; Cavagni, G.; Menzies, I.S.; Bertolini, P.; Atherton, D.J. Elimination diet and intestinal permeability in atopic eczema: A preliminary study. Clin. Exp. Allergy 1993, 23, 28–31. [Google Scholar] [CrossRef] [PubMed]
- Caffarelli, C.; Coscia, A.; Baldi, F.; Borghi, A.; Capra, L.; Cazzato, S.; Migliozzi, L.; Pecorari, L.; Valenti, A.; Cavagni, G. Characterization of irritable bowel syndrome and constipation in children with allergic diseases. Eur. J. Pediatr. 2007, 166, 1245–1252. [Google Scholar] [CrossRef] [PubMed]
- Özhan, A.K.; Arıkoğlu, T. Evaluation of Pediatric Chronic Urticaria with Emphasis on Clinical and Laboratory Characteristics and Treatment Response to Omalizumab: A real-life experience from a tertiary allergy center. Children 2024, 11, 86. [Google Scholar] [CrossRef] [PubMed]
- Alangari, A.A.; Twarog, F.J.; Shih, M.-C.; Schneider, L.C. Clinical features and anaphylaxis in children with cold urticaria. Pediatrics 2004, 113, e313–e317. [Google Scholar] [CrossRef] [PubMed]
- Staevska, M.; Popov, T.A.; Kralimarkova, T.; Lazarova, C.; Kraeva, S.; Popova, D.; Church, D.S.; Dimitrov, V.; Church, M.K. The Effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J. Allergy Clin. Immunol. 2010, 125, 676–682. [Google Scholar] [CrossRef] [PubMed]
- Özçeker, D.; Can, P.K.; Terzi, Ö.; Ornek, S.A.; Değirmentepe, E.N.; Kızıltac, K.; Sarac, E.; Kocatürk, E. Differences between adult and pediatric chronic spontaneous urticaria from a cohort of 751 patients: Clinical features, associated conditions and indicators of treatment response. Pediatr. Allergy Immunol. 2023, 34, e13925. [Google Scholar] [CrossRef]
- Gabrielli, S.; Le, M.; Netchiporouk, E.; Miedzybrodzki, B.; Baum, S.; Greenberger, S.; Staubach-Renz, P.; Ben-Shoshan, M. Chronic urticaria in children can be controlled effectively with updosing second-generation antihistamines. J. Am. Acad. Dermatol. 2020, 82, 1535–1537. [Google Scholar] [CrossRef]
- Sarti, L.; Barni, S.; Giovannini, M.; Liccioli, G.; Novembre, E.; Mori, F. Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria. Pediatr. Allergy Immunol. 2021, 32, 153–160. [Google Scholar] [CrossRef] [PubMed]
- Goldstein, S.; Gabriel, S.; Kianifard, F.; Ortiz, B.; Skoner, D.P. Clinical features of adolescents with chronic idiopathic or spontaneous urticaria: Review of omalizumab clinical trials. Ann. Allergy Asthma Immunol. 2017, 118, 500–504. [Google Scholar] [CrossRef] [PubMed]
- Dekkers, C.; Alizadeh Aghdam, M.; de Graaf, M.; Knulst, A.C.; Meijer, Y.; Van den Reek, J.M.P.A.; Stadermann, M.B.; Röckmann, H. Safety and effectiveness of omalizumab for the treatment of chronic urticaria in pediatric patients. Pediatr. Allergy Immunol. 2021, 32, 720–726. [Google Scholar] [CrossRef] [PubMed]
- Song, X.T.; Chen, Y.D.; Yu, M.; Liu, B.; Zhao, Z.T.; Maurer, M. Omalizumab in children and adolescents with chronic urticaria: A 16-week real-world study. Allergy 2021, 76, 1271–1273. [Google Scholar] [CrossRef] [PubMed]
- Ocak, M.; Soyer, O.; Buyuktiryaki, B.; Sekerel, B.E.; Sahiner, U.M. Omalizumab treatment in adolescents with chronic spontaneous urticaria: Efficacy and safety. Allergol. Immunopathol. 2020, 48, 368–373. [Google Scholar] [CrossRef] [PubMed]
- Konstantinou, G.N.; Asero, R.; Ferrer, M.; Knol, E.F.; Maurer, M.; Raap, U.; Schmid-Grendelmeier, P.; Skov, P.S.; Grattan, C.E. EAACI taskforce position paper: Evidence for autoimmune urticaria and proposal for defining diagnostic criteria. Allergy 2013, 68, 27–36. [Google Scholar] [CrossRef]
- Tsabouri, S.; Arasi, S.; Beken, B.; Church, M.K.; Alvaro-Lozano, M.; Caffarelli, C.; Flohr, C.; Janmohamed, S.R.; Konstantinou, G.N.; Lau, S.; et al. A European survey of management approaches in chronic urticaria in children: EAACI Pediatric Urticaria Taskforce. Pediatr. Allergy Immunol. 2022, 33, e13674. [Google Scholar] [CrossRef]
Characteristics | Frequency |
---|---|
Family history (n) | |
| 4 (10.81%) [2 mothers with CSU, 1 CSU was autoimmune; 1 mother with CIU (pressure urticaria); 1 father with CU (the type was unknown)] |
| 29 (78.38%) |
| 4 (10.81%) |
Comorbidity history (n) | |
| 14 (37.84%) 9 (24.32%) 8 (21.62%) 7 (18.92%) 3 (8.11%) 1 (2.70%) |
| 3 (8.11%) 1 (2.70%) 1 (2.70%) |
| 1 (2.70%) 1 (2.70%) 1 (2.70%) 1 (2.70%) |
Severity Recurrent course/continuous course (n) | 2 (5.41%)/35 (94.59%) |
Days a week with symptoms (mean, median, range) | 5.93 in the 4 weeks before medical examination (7, 3–7); data lacking in 10 (27.03%) clinical cards |
Clinical manifestations of patients (n)
| 26 (70.27%) 11 (29.73%) |
UAS7 (mean, median, range) | 22.77, 19, 8–50 |
UCT (mean, median, range) | 4.86, 5, 2–10 |
Severity of CU (n)
| 0 (0%) 0 (0%) 7 (18.92%) (7 males) 7 (18.92%) (6 females and 1 male) 8 (21.62%) (7 females and 1 male); |
Characteristics | Frequency |
---|---|
Age at onset, years (mean, median, range) (n = 37) | 8, 7.3, 0.5–17.1 |
Age at recovery, years (mean, median, range) (n = 19) | 10.2, 10, 1.9–19 |
Children dropped out during follow up (n) | 8 (21.62%) |
Children still affected at last visit (n) | 10 (27.02%) |
Duration of CU in still affected children, years (mean, median, range) | 4.9, 3.9, 1.7–12 |
Duration of CU in recovered children, years (mean, median, range) | 1.8, 1.3, 0.6–7.3 |
Variables | Number of Children | CU Remission with Treatment |
---|---|---|
Graves’ disease | 1/37 (2.70%) | 0/1 |
Reduced TSH and high T4 levels | 1/35 (2.86%) | |
Positive thyroid antibody levels | 1/27 (3.70%) | |
Coeliac disease | 1/37 (2.70%) | 0/1 |
Positive anti-tissue transglutaminase antibody | 1/36 (2.78%) | |
Positive deamidated gliadin peptide antibodies | 1/36 (2.78%) | |
Positive throat swab for GABHS | 1/6 (16.67%) | 0/1 |
Positive ASO titer | 1/1 (100%) | |
Positive parasites in stools (n = 18) | 1/18 (5.56%) (Dientamoeba Fragilis) | 1/1 (100%) |
Antibodies to virus | 0/3 | |
| 17/34 (50%) | |
| 15/34 (44.11%) | |
| 7/34 (20.59%) | |
| 3/34 (8.82%) | |
| 1/34 (2.94%) | |
| 1/34 (2.94%) | |
| 1/34 (2.94%) | |
| 1/34 (2.94%) | |
Anti-mycoplasma pneumoniae antibodies | 0/9 | |
| 10/32 (31.25%) | |
| 9/32 (28.13%) | |
Positive challenge tests for CIU: | ||
| 1/37 (2.70%) | |
| 0/1 | |
| 1/1 (2.70%) |
Drug | Number of Children |
---|---|
Second-generation H1-antihistamine | |
| 29/37 (78.38%) |
| 4/37 (10.81%) |
| 2/37 (5.41%) |
| 1/37 (2.70%) |
| 1/37 (2.70%) |
Dosage of second-generation H1-antihistamine | |
| 27/37 (72.97%) |
| 10/37 (27.03%) |
Response to H1-antistamine therapy | |
| 6/37 (16.22%) Standard dose: 3 Twofold the dose: 3 |
| 23/37 (62.16%) Standard dose: 21 Twofold the dose: 2 |
| 8/37 (21.62%) Standard dose: 3 Twofold the dose: 5 |
Systemic glucocorticoids | 13/37 (35.14%) |
| 9/13 (69.23%) |
| 4/13 (30.77%) |
Response to systemic glucocorticoids | |
| 8/13 (61.54%) |
| 5/13 (38.46%) |
Omalizumab | 6/37 (16.21%) |
Response to omalizumab | |
| 1/6 (16.67%) |
| 5/6 (83.33%) |
| 2/6 (33.33%) |
| 1/2 (50%) |
| 1/2 (50%) |
Unresponsive | 0 |
Montelukast Response | 2/37 (5.41%) 0/2 (0%) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Buono, E.V.; Giannì, G.; Scavone, S.; Caffarelli, C. Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study. Medicina 2024, 60, 704. https://doi.org/10.3390/medicina60050704
Buono EV, Giannì G, Scavone S, Caffarelli C. Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study. Medicina. 2024; 60(5):704. https://doi.org/10.3390/medicina60050704
Chicago/Turabian StyleBuono, Enrico Vito, Giuliana Giannì, Sara Scavone, and Carlo Caffarelli. 2024. "Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study" Medicina 60, no. 5: 704. https://doi.org/10.3390/medicina60050704