Management of chronic urticaria in children: a clinical guideline

doi:10.1186/s13052-019-0695-x

Practice Guideline

. 2019 Aug 15;45(1):101.

doi: 10.1186/s13052-019-0695-x.

Management of chronic urticaria in children: a clinical guideline

Carlo Caffarelli¹, Francesco Paravati², Maya El Hachem³, Marzia Duse⁴, Marcello Bergamini⁵, Giovanni Simeone⁶, Massimo Barbagallo⁷, Roberto Bernardini⁸, Paolo Bottau⁹, Filomena Bugliaro¹⁰, Silvia Caimmi¹¹, Fernanda Chiera², Giuseppe Crisafulli¹², Cristiana De Ranieri¹³, Dora Di Mauro¹⁴, Andrea Diociaiuti³, Fabrizio Franceschini¹⁵, Massimo Gola¹⁶, Amelia Licari¹¹, Lucia Liotti¹⁷, Carla Mastrorilli¹⁸, Domenico Minasi¹⁹, Francesca Mori²⁰, Iria Neri²¹, Aurelia Pantaleo²², Francesca Saretta^{23

24}, Carlo Filippo Tesi¹⁰, Giovanni Corsello²⁵, Gian Luigi Marseglia¹¹, Alberto Villani²⁶, Fabio Cardinale²⁷

Affiliations

¹ Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy.
² Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy.
³ Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
⁵ Generalist Pediatrician, Local Health Unit of Ferrara, Ferrara, Italy.
⁶ Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy.
⁷ Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy.
⁸ Paediatric Unit, "San Giuseppe" Hospital, Empoli, Italy.
⁹ Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy.
¹⁰ FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy.
¹¹ Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
¹² UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy.
¹³ Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy.
¹⁵ UOC Pediatria, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
¹⁶ Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy.
¹⁷ Department of Pediatrics, Senigallia Hospital, Senigallia, Italy.
¹⁸ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
¹⁹ UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
²⁰ Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
²¹ Dermatology Unit, University of Bologna, Bologna, Italy.
²² Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
²³ Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.
²⁴ Pediatric Allergy Unit, Department of Medicine, Udine, Italy.
²⁵ Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy.
²⁶ UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
²⁷ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy. fabiocardinale@libero.it.

PMID: 31416456
PMCID: PMC6694633
DOI: 10.1186/s13052-019-0695-x

Practice Guideline

Management of chronic urticaria in children: a clinical guideline

Carlo Caffarelli et al. Ital J Pediatr. 2019.

. 2019 Aug 15;45(1):101.

doi: 10.1186/s13052-019-0695-x.

Authors

Affiliations

¹ Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy.
² Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy.
³ Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
⁵ Generalist Pediatrician, Local Health Unit of Ferrara, Ferrara, Italy.
⁶ Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy.
⁷ Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy.
⁸ Paediatric Unit, "San Giuseppe" Hospital, Empoli, Italy.
⁹ Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy.
¹⁰ FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy.
¹¹ Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
¹² UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy.
¹³ Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy.
¹⁵ UOC Pediatria, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
¹⁶ Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy.
¹⁷ Department of Pediatrics, Senigallia Hospital, Senigallia, Italy.
¹⁸ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
¹⁹ UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
²⁰ Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
²¹ Dermatology Unit, University of Bologna, Bologna, Italy.
²² Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
²³ Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.
²⁴ Pediatric Allergy Unit, Department of Medicine, Udine, Italy.
²⁵ Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy.
²⁶ UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
²⁷ Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy. fabiocardinale@libero.it.

PMID: 31416456
PMCID: PMC6694633
DOI: 10.1186/s13052-019-0695-x

Abstract

The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.

Keywords: Allergy; Angioedema; Children; Chronic spontaneous urticaria; Chronic urticaria; Inducible uricaria; Management; Omalizumab; Pathogenesis; Pediatric; Therapy; Urticaria.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Algorithm for diagnosis of subtypes of CU

**Fig. 2**
Treatment of CU in children. *off-label

See this image and copyright information in PMC

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References

1. Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003;88:517. doi: 10.1136/adc.88.6.517. - DOI - PMC - PubMed
1. Caminiti L, Passalacqua G, Magazzù G, Comisi F, Vita D, Barberio G, et al. Chronic urticaria and associated coeliac disease in children: a case–control study. Pediatr Allergy Immunol. 2005;16:428–432. doi: 10.1111/j.1399-3038.2005.00309.x. - DOI - PubMed
1. Hoffman WH, Helman SW, Sekul E, Carroll JE, Vega RA. Lambert–Eaton myasthenic syndrome in a child with an autoimmune phenotype. Am J Med Genet A. 2003;119:77–80. doi: 10.1002/ajmg.a.20022. - DOI - PubMed
1. Church MK, Weller K, Stock P, Maurer M. Chronic spontaneous urticaria in children: itching for insight. Pediatr Allergy Immunol. 2011;22:1–8. doi: 10.1111/j.1399-3038.2010.01120.x. - DOI - PubMed
1. Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155:145–151. doi: 10.1111/j.1365-2133.2006.07185.x. - DOI - PubMed

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[1] Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003;88:517. doi: 10.1136/adc.88.6.517. - DOI - PMC - PubMed

[2] Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003;88:517. doi: 10.1136/adc.88.6.517. - DOI - PMC - PubMed

[3] Caminiti L, Passalacqua G, Magazzù G, Comisi F, Vita D, Barberio G, et al. Chronic urticaria and associated coeliac disease in children: a case–control study. Pediatr Allergy Immunol. 2005;16:428–432. doi: 10.1111/j.1399-3038.2005.00309.x. - DOI - PubMed

[4] Caminiti L, Passalacqua G, Magazzù G, Comisi F, Vita D, Barberio G, et al. Chronic urticaria and associated coeliac disease in children: a case–control study. Pediatr Allergy Immunol. 2005;16:428–432. doi: 10.1111/j.1399-3038.2005.00309.x. - DOI - PubMed

[5] Hoffman WH, Helman SW, Sekul E, Carroll JE, Vega RA. Lambert–Eaton myasthenic syndrome in a child with an autoimmune phenotype. Am J Med Genet A. 2003;119:77–80. doi: 10.1002/ajmg.a.20022. - DOI - PubMed

[6] Hoffman WH, Helman SW, Sekul E, Carroll JE, Vega RA. Lambert–Eaton myasthenic syndrome in a child with an autoimmune phenotype. Am J Med Genet A. 2003;119:77–80. doi: 10.1002/ajmg.a.20022. - DOI - PubMed

[7] Church MK, Weller K, Stock P, Maurer M. Chronic spontaneous urticaria in children: itching for insight. Pediatr Allergy Immunol. 2011;22:1–8. doi: 10.1111/j.1399-3038.2010.01120.x. - DOI - PubMed

[8] Church MK, Weller K, Stock P, Maurer M. Chronic spontaneous urticaria in children: itching for insight. Pediatr Allergy Immunol. 2011;22:1–8. doi: 10.1111/j.1399-3038.2010.01120.x. - DOI - PubMed

[9] Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155:145–151. doi: 10.1111/j.1365-2133.2006.07185.x. - DOI - PubMed

[10] Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155:145–151. doi: 10.1111/j.1365-2133.2006.07185.x. - DOI - PubMed

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Management of chronic urticaria in children: a clinical guideline

Affiliations

Management of chronic urticaria in children: a clinical guideline

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