Journal List > Allergy Asthma Respir Dis > v.5(4) > 1059261

Cho, Choi, Kim, and Jung: Factors associated with the treatment of chronic spontaneous urticaria in children

Abstract

Purpose

Chronic spontaneous urticaria (CSU) in children is a common skin disorder, but its clinical course varies. We investigated the clinical course and associated factors for CSU treatment in children.

Methods

A total of 107 children, diagnosed with CSU from 2001 to 2016 in Dong-A University Hospital, who had been followed up for more than 6 months after treatment, were enrolled. The laboratory findings, and clinical aspects and courses were retrospectively investigated by a medical record review. We divided the 152 patients into 3 groups according to the treatment modalities: group 1, 1 antihistamine; group 2, more than 2 kinds of antihistamines; and group 3, antihistamines plus leukotriene receptor antagonist.

Results

The mean age of patients in group 3 was 3.4 years (range, 2.6–4.2 years), which was significantly lower than those at the other 2 group patients (P=0.01). The urticaria activity score (UAS) of group 3 (6.1 [5.7–6.6]) was significantly higher compared to those of the other 2 groups (P=0.01). The improvement rate of the condition in children with positive specific immunoglobulin E (sIgE) reactivity to food or inhalant allergens was significantly lower than that of children with negative sIgE reactivity (P=0.01). Sex, age, history of allergic diseases, disease duration, UAS, previous treatment, and treatment modality were not correlated with the symptom improvement rate.

Conclusion

Younger children and those with higher UAS needed more medication to ensure the improvement in symptoms. More-over, it took more time for the improvement in symptoms in children who were sensitized to food or inhalant allergens.

REFERENCES

1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69:868–87.
2. Yu J. Chronic urticaria in children. Allergy Asthma Respir Dis. 2014; 2:236–42.
crossref
3. Marrouche N, Grattan C. Childhood urticaria. Curr Opin Allergy Clin Immunol. 2012; 12:485–90.
crossref
4. Leech S, Grattan C, Lloyd K, Deacock S, Williams L, Langford A, et al. The RCPCH care pathway for children with urticaria, angio-oedema or mastocytosis: an evidence and consensus based national approach. Arch Dis Child. 2011; 96(Suppl 2):i34–7.
crossref
5. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med. 2002; 346:175–9.
6. Sahiner UM, Civelek E, Tuncer A, Yavuz ST, Karabulut E, Sackesen C, et al. Chronic urticaria: etiology and natural course in children. Int Arch Allergy Immunol. 2011; 156:224–30.
crossref
7. Kilic G, Guler N, Suleyman A, Tamay Z. Chronic urticaria and autoimmunity in children. Pediatr Allergy Immunol. 2010; 21:837–42.
crossref
8. Dalal I, Levine A, Somekh E, Mizrahi A, Hanukoglu A. Chronic urticaria in children: expanding the "autoimmune kaleidoscope". Pediatrics. 2000; 106:1139–41.
crossref
9. Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003; 88:517–9.
crossref
10. Młynek A, Zalewska-Janowska A, Martus P, Staubach P, Zuberbier T, Maurer M. How to assess disease activity in patients with chronic urticaria? Allergy. 2008; 63:777–80.
crossref
11. Kelso JM, Sodhi N, Gosselin VA, Yunginger JW. Diagnostic performance characteristics of the standard Phadebas RAST, modified RAST, and pharmacia CAP system versus skin testing. Ann Allergy. 1991; 67:511–4.
12. Zuberbier T, Greaves MW, Juhlin L, Merk H, Stingl G, Henz BM. Management of urticaria: a consensus report. J Investig Dermatol Symp Proc. 2001; 6:128–31.
crossref
13. Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CE, Greaves MW, Henz BM, et al. EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy. 2006; 61:321–31.
crossref
14. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009; 64:1427–43.
15. Hiragun M, Hiragun T, Mihara S, Akita T, Tanaka J, Hide M. Prognosis of chronic spontaneous urticaria in 117 patients not controlled by a standard dose of antihistamine. Allergy. 2013; 68:229–35.
crossref
16. Harris A, Twarog FJ, Geha RS. Chronic urticaria in childhood: natural course and etiology. Ann Allergy. 1983; 51(2 Pt 1):161–5.
17. Kang HS, Shin MY. Clinical aspects of chronic urticaria in children. Korean J Pediatr. 2009; 52:205–12.
crossref
18. Ye YM, Park JW, Kim SH, Ban GY, Kim JH, Shin YS, et al. Prognostic factors for chronic spontaneous urticaria: a 6-month prospective observational study. Allergy Asthma Immunol Res. 2016; 8:115–23.
crossref
19. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol. 2012; 129:1307–13.
crossref
20. Lee SY, Song WJ, Jung JW, Park HW, Cho SH, Min KU, et al. Thyroid autoantibodies and the prognosis of chronic idiopathic urticaria. Allergy Asthma Respir Dis. 2013; 1:151–6.
crossref
21. Kjellman NM, Johansson SG, Roth A. Serum IgE levels in healthy children quantified by a sandwich technique (PRIST). Clin Allergy. 1976; 6:51–9.
crossref
22. Chung HL. Clinical significance of serum IgE. Korean J Pediatr. 2007; 50:416–21.
crossref
23. Amarasekera M. Immunoglobulin E in health and disease. Asia Pac Allergy. 2011; 1:12–5.
crossref
24. Lee JH, Kim JH, Yun SW, Han YS, Ahn K, Chae SA, et al. Differences of the clinical manifestations and laboratory tests between monosensitized and polysensitized children: a single center study. Pediatr Allergy Respir Dis. 2011; 21:277–84.
crossref
25. Choi SY, Park HY, Ahn YM. Chronic urticaria in childhood: etiology and outcome. Pediatr Allergy Respir Dis. 2007; 17:38–47.

Table 1.
Subjects’ characteristics according to treatment step
Variable Treatment steps P-value
Step 1 (n=54) Step 2 (n=22) Step 3 (n=31)
Male sex 24 (44.4) 13 (59.1) 17 (54.8) 0.43
Age (yr) 5.9 (4.9–7.0) 4.9 (3.4–6.5) 3.4 (2.6–4.2) 0.01
Other allergic diseases of patients 27 (50.0) 9 (40.9) 14 (45.2) 0.76
Allergic diseases of parents 21 (38.9) 7 (31.8) 10 (32.3) 0.76
Allergic diseases of siblings 9 (16.7) 2 (9.1) 7 (22.6) 0.43
Duration of symptoms at the first visit (mo) 5.2 (3.8–6.6) 6.7 (3.5–9.9) 7.0 (3.5–10.6) 0.79
Urticaria activity score at the first visit 6.1 (5.7–6.6) 5.9 (5.3–6.5) 7.1 (6.4–7.8) 0.03
Previous treatment 38 (70.4) 17 (77.3) 23 (74.2) 0.81
Total eosinophil count (/mm3) 227.3 (191.0–263.6) 275.9 (201.6–350.2) 249.3 (157.8–340.9) 0.12
Total IgE (kU/L) 187.0 (98.7–275.3) 194.7 (28.6–360.7) 108.0 (64.2–151.7) 0.41
Presence of allergen-specific IgE 17 (37.0) 11 (57.9) 12 (44.4) 0.30

Values are presented as number (%) or mean (95% confidence interval). P-values were calculated by chi-square test for trend or analysis of variance test.

Table 2.
Clinical factors associated with urticaria improvement rate
Variable No. of the patients Estimated improvement rate (%)
Mean duration until the improvement from the treatment (95% CI) P-value
1 Week 2 Weeks 8 Weeks 24 Weeks
Sex             0.34
 Female 53 17.0 62.3 77.4 92.4 1.9 (1.0–2.7)  
 Male 54 13.0 53.7 85.2 96.3 1.4 (0.9–1.9)  
Age (yr)             0.27
 ≤2 23 21.8 78.3 82.6 91.3 2.0 (0.2–3.7)  
 >2, ≤6 56 14.3 48.2 80.4 94.7 1.7 (1.1–2.2)  
 >6 28 10.7 60.7 82.1 96.4 1.3 (0.7–2.0)  
Other allergic diseases of patients             0.16
 No 57 22.8 64.9 84.2 94.8 1.5 (0.7–2.2)  
 Yes 50 6.0 50.0 78.0 94.0 1.8 (1.2–2.5)  
Allergic diseases of parents             0.23
 No 69 15.9 60.9 81.2 91.3 1.8 (1.1–2.5)  
 Yes 38 13.2 52.6 81.6 100 1.4 (0.9–1.9)  
Allergic diseases of siblings             0.62
 No 54 14.8 51.9 85.2 94.4 1.8 (1.0–2.6)  
 Yes 19 15.8 57.9 73.7 89.5 2.0 (0.7–3.3)  
Duration of symptoms at the first visit (mo)             0.95
 ≤6 83 15.7 57.8 81.9 94.0 1.7 (1.1–2.3)  
 >6 24 12.5 58.3 79.2 95.9 1.5 (0.7–2.2)  
UAS at the first visit             0.45
 ≤6 61 19.7 64.0 85.2 95.1 1.5 (0.8–2.1)  
 >6 46 8.7 50.0 76.1 93.5 1.9 (1.1–2.6)  
Previous treatment             0.95
 No 29 13.8 55.2 82.8 96.6 1.5 (0.9–2.2)  
 Yes 78 15.4 59.0 80.8 93.6 1.7 (1.1–2.3)  
TEC (/mm3)             0.17
 <450 97 16.5 60.8 82.5 93.8 1.6 (1.1–2.1)  
 ≥450 10 0 30 70 100 2.0 (0.7–3.2)  
Total IgE (kU/L)             0.19
 <200 82 18.3 59.8 81.7 92.7 1.7 (1.1–2.3)  
 ≥200 25 4 52 80 100 1.5 (0.9–2.2)  
Presence of allergen-specific IgE             0.01
 No 52 23.1 60.0 75.0 90.4 2.0 (1.1–2.9)  
 Yes 40 2.5 52.5 85 97.5 1.4 (0.9–1.8)  
Treatment steps             0.56
 1 54 16.7 29.3 87.0 98.2 1.1 (0.8–1.5)  
 2 22 18.2 59.1 77.3 95.5 1.7 (0.8–2.6)  
 3 31 9.7 54.8 74.2 87.1 2.5 (1.1–3.9)  

P-values were calculated by chi-square test for trend.

CI, confidence interval; UAS, urticaria activity score; TEC, total eosinophil count.

TOOLS
Similar articles