Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Dec 20:43:e2024107.
doi: 10.1590/1984-0462/2025/43/2024107. eCollection 2024.

Chronic urticaria treatment challenges in children

Luis Felipe Ensina  1 , Larissa Silva Brandão  1 , Ana Caroline Dela Bianca Melo  2 , Martti Antila  3 , Moshe Ben-Shoshan  4 , Dirceu Solé  1
Affiliations
Review

Chronic urticaria treatment challenges in children

Luis Felipe Ensina et al. Rev Paul Pediatr. .

Abstract
in English, Portuguese

Objective: This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group.

Data source: Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents).

Data synthesis: According to the current guideline's algorithm, the treatment of CU involves using high doses of antihistamines when there is no response with the licensed dosage. The effectiveness of this increase in children has been demonstrated with control rates ranging from 35% to 92%, with few studies addressing safety profiles. Omalizumab is approved for children over 12 years of age as a second step in the algorithm. Although more studies with children are needed to assess its effectiveness and safety, some data show complete control of symptoms in more than 80% of pediatric cases with no adverse effects, including in children under 12 years. When monitored closely, cyclosporine showed a good response rate in pediatric CU with few adverse events. Also, PROMs validated for this age can be helpful in clinical decisions, such as Urticaria Activity Score summed over 7 days, Urticaria Control Test, and Chronic Urticaria Quality of Life Questionnaire.

Conclusions: Collaborative studies are necessary to generate stronger evidence to support the guideline recommendations for children. The existing data indicate that these drugs are safe and effective for treatment when dose adjustments are made.

Objetivo:: Esta revisão avalia o tratamento da urticária crônica (UC), sua eficácia e segurança em crianças, além das ferramentas de avaliação de resultados (PROMS) específicas para essa faixa etária.

Fonte de dados:: Dada a escassez de estudos em crianças, os autores realizaram uma revisão não sistemática de artigos publicados em inglês, espanhol e português na última década nos bancos de dados da United States National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO) e Embase. As palavras-chave utilizadas foram anti-histamínicos OU omalizumabe OU ciclosporina OU tratamento E urticária crônica E crianças OU adolescentes.

Síntese dos dados:: O tratamento padrão da UC envolve o uso de altas doses de anti-histamínicos em casos refratários à dose licenciada. Estudos mostraram eficácia desse aumento de dose em crianças, com taxas de controle variando entre 35 e 92%, embora haja poucos estudos sobre segurança. O omalizumabe é aprovado para crianças com mais de 12 anos de idade como segunda etapa de tratamento, com alguns dados indicando controle completo dos sintomas em mais de 80% dos casos infantis, sem eventos adversos, mesmo em menores de 12 anos. A ciclosporina, quando monitorada adequadamente, mostrou boa resposta na UC pediátrica, com poucos eventos adversos relatados. Além disso, PROMS validados para a idade, como UAS7, UCT, CU-Q2oL, podem ser úteis nas decisões clínicas.

Conclusões:: Embora mais estudos colaborativos sejam necessários para apoiar as recomendações das diretrizes em crianças, os dados existentes demonstram que esses medicamentos são seguros e eficazes para o tratamento da UC pediátrica, desde que haja ajuste adequado de doses.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: Luis Felipe Ensina: funding from Novartis for clinical trials, speaker from Novartis, Sanofi, and Abbvie, and consultant for Novartis and Sanofi. Moshe Ben-Shoshan: consultant for Novartis and Sanofi. Martti Antila: Abbvie, Pfizer, Angion Biomedica Corp, AstraZeneca, BeiGene, EMS, Eurofarma, GSK, Humanigen, Janssen, Novartis, Sanofi – clinical trial funding; Aché, AstraZeneca, GSK, Chiesi, Eurofarma, IPI ASAC Brasil, Sanofi – honoraria; AstraZeneca, GSK, Novartis, Sanofi – meeting or travel support; and Abbott, AstraZeneca, Chiesi, Sanofi, Zambon – data safety monitoring board and/or advisory board member. Larissa Silva Brandão, Ana Caroline Dela Bianca Melo and Dirceu Solé: nothing to declare.

Figures

Figure 1
Figure 1. Chronic urticaria: management decisions and treatment adjustments.
Figure 2
Figure 2. Recommended treatment algorithm for chronic urticaria.
See this image and copyright information in PMC

References

    1. Zuberbier T, Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77:734–66. doi: 10.1111/all.15090. - DOI - PubMed
    1. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133:1270–7. doi: 10.1016/j.jaci.2014.02.036. - DOI - PubMed
    1. Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, et al. Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy. 2020;75:423–32. doi: 10.1111/all.14037. - DOI - PubMed
    1. Özçeker D, Can PK, Terzi Ö, Ornek SA, Degirmentepe EN, Kiziltac K, et al. 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. doi: 10.1111/pai.13925. - DOI - PubMed
    1. Sandoval-Ruballos M, Domínguez O, Landazuri IO, Gereda D, Cisneros EM, Sequeira FQ, et al. Pediatric chronic urticaria: clinical and laboratory characteristics and factors linked to remission. Pediatr Allergy Immunol. 2023;34:e13929. doi: 10.1111/pai.13929. - DOI - PubMed

MeSH terms

LinkOut - more resources