Asthma, Allergy and Immunology

Biography

Biography: Hugo P S Van Bever

Abstract

Studies in children have shown that urticaria occurs in about 5% to 7% of non-selected preschool children and in 17% of young children suffering from an underlying atopic disease. Acute urticaria (i.e. less than six weeks) is more frequently seen in young people and children and is usually linked to atopy, while chronic urticaria more frequently occurs in adults, mainly in middle-aged, non-allergic women. If chronic urticaria presents in children, an underlying immunologic or auto-immune disorder should be ruled out. A direct etiological cause can be suspected in >50% of acute urticaria, while this is only the case in about 20% in chronic urticaria. Acute urticaria in children can be caused by a number of triggers including allergens (food and inhalants), medication and infections (viral, bacterial and parasitic infections). There is still some confusion on the classification of urticaria. Most authors divide into three main types: Acute, chronic and physical but other classifications have been proposed. Children with chronic urticaria, in particular those having systemic symptoms (fever, weight loss, joint pain), deserve a diagnostic work-up. In these children it is important to rule out systemic diseases, malignancy, endocrine disorders and chronic infections. In children with persistent and severe painful lesions, without pruritus, urticarial vasculitis needs to be ruled out by skin biopsy. In older children suffering from (recurrent) angioedema without concomitant urticaria and sometimes presenting are recurrent attacks of abdominal pain, C1 esterase inhibitor deficiency should be excluded, even if the family history is negative (i.e. acquired deficiency). Except for the patients for whom an avoidable cause can be identified (such as food), treatment of urticaria is symptomatic. Treatment depends on the severity of symptoms. Scattered or mild hives are self-limited and usually require no treatment or at most a mild antihistamine as needed. In a number of comparative trials between the various non-sedating (2^nd generation) agents, no significant difference in efficacy has been noted. All the agents have good safety profiles in children. Cetirizine has the most extensive safety profile in infants, showing efficacy in acute urticaria. In cases of severe urticaria immuno-modulatory treatments might be necessary such as systemic corticosteroids or anti-IgE.