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Review
. 2021 Mar 9:14:187-199.
doi: 10.2147/JAA.S249765. eCollection 2021.

Management of Pediatric Chronic Spontaneous Urticaria: A Review of Current Evidence and Guidelines

Jasmine Chang  1 , Leila Cattelan  2 , Moshe Ben-Shoshan  3 , Michelle Le  2 , Elena Netchiporouk  2
Affiliations
Review

Management of Pediatric Chronic Spontaneous Urticaria: A Review of Current Evidence and Guidelines

Jasmine Chang et al. J Asthma Allergy. .

Abstract

Chronic urticaria (CU) is associated with debilitating symptoms such as pruritic wheals and/or angioedema, which can significantly affect patients' sleep, productivity and quality of life. Chronic spontaneous urticaria (CSU) is defined in cases in which no triggering factor is identified. Various guidelines directing the optimal management of CU in the adult population were published and updated over the recent years with the most accepted and widely used being the EAACI/GA2LEN/EDF/WAO 2017 guidelines. Meanwhile, guidelines specific to the pediatric population are scarce, mainly due to the fact that high quality evidence is lacking for many treatment options in this age group. The objective of this article is to review and synthesize the existing literature regarding the management of pediatric CSU. Our review highlights evidence supporting the EAACI/GA2LEN/EDF/WAO 2017 treatment guidelines with non-sedating second-generation antihistamines (sgAHs) as the mainstay of treatment for pediatric CSU, considering their demonstrated efficacy and reassuring safety profile. Additionally, the use of omalizumab in adolescents is well supported by the current literature. There is limited data available regarding the updosing of sgAHs, omalizumab in children with CSU under 12 years of age and the treatment with cyclosporine and leukotriene receptor antagonists (LTRAs) in pediatric patients of all ages. However, the results from currently available case series and case reports are promising for omalizumab and cyclosporine use in children with CSU, although large and well-designed randomized control trials (RCTs) assessing these treatment options are needed in order to formulate strong recommendations for their use. First-generation antihistamines (fgAHs) remain commonly used in pediatric CSU treatment despite a lack of studies assessing their efficacy and safety in the pediatric population and their widely known inferior safety profile compared to sgAHs.

Keywords: children; chronic spontaneous urticaria; CSU; chronic urticaria; CU; guidelines; management; pediatric; treatment.

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Conflict of interest statement

Dr. Ben-Shoshan is a consultant, speaker and investigator for Novartis and participated in a clinical trial related to the use of ligelizumab. Dr. Elena Netchiporouk has received investigator-initiated project grants from Eli Lilly, LEO Pharma, Beiersdorf, AbbVie and has served as a consultant/advisory for Leo pharma, Sanofi Genzyme, Eli Lilly, Novartis, Bausch, Janssen, Galderma (advisory board only). She has served as a speaker for Bausch, Janssen, Novartis, Sun Pharma and LEO Pharma. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Pathogenesis of chronic spontaneous urticaria (CSU) – current concepts.
Figure 2
Figure 2
Pediatric CSU treatment guidelines.
See this image and copyright information in PMC

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