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. 2025 Aug;36(8):e70174.
doi: 10.1111/pai.70174.

An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI Task Force report

Stefania Arasi  1 , Helena Pite  2   3 , Burcin Beken  4 , Montserrat Alvaro-Lozano  5   6   7 , Helen Brough  8   9 , Carlo Caffarelli  10 , Martin K Church  11 , Carlo Carsten Flohr  12 , Sherief R Janmohamed  13 , George N Konstantinou  14 , Susanne Lau  15 , Marcus Maurer  16   17 , Charlotte G Mortz  18 , Krzysztof Rutkowski  19 , Petra Staubach-Renz  20 , Lauri-Ann Van der Poel  21 , Torsten Zuberbier  16 , Karsten Weller  16 , Sophia Tsabouri  22
Affiliations

An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI Task Force report

Stefania Arasi et al. Pediatr Allergy Immunol. 2025 Aug.

Abstract

Background: The EAACI Task Force entitled "Improving Chronic Urticaria (CU) Management in Pediatrics" aimed to explore the differences in the diagnostic and management practices for CU in children (0-18 years).

Methods: An online clinical survey including 41 multiple choice questions on current practices for the management of childhood CU was disseminated among EAACI members.

Results: The survey was circulated to 50,472 contacts via mass email and to 2343 contacts via EAACI social media channels and answered by 161 participants from 55 countries. Most respondents were pediatric allergists (74.5%). While 68.3% of the respondents stated that they use the EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline, 10.6% declared that they do not use any guideline. Full blood count (83.3%), thyroid profile (64.6%), IgE (62.7%), thyroid antibodies (62.1%), C-reactive protein (59%), and antinuclear antibodies (ANA) or other antibodies (50.9%) were the most commonly used routine tests when diagnosing CU patients. Less than 20% of the respondents said they test their patients routinely for chronic induced urticaria when clinically suspected. Reasons for not testing at all were a lack of needed equipment or not knowing how to perform the test. In patients who do not respond to second-generation antihistamine standard dose, two to four-times increased dosage was the preferred step, independently of the child's age. Many participants do not prescribe omalizumab in children aged <5 years (77.6%), 6-11 years (45%), and adolescents (24.7%). In children who do not respond to omalizumab, almost half of the prescribing clinicians stated that they prefer oral ciclosporin-A, and 20% use oral corticosteroids.

Conclusions: Some challenges to the effective use of evidence-based CU guidelines persist around basic testing in the diagnostic workup and pharmacological treatment in children. This study suggests the need for broader availability of specific testing tools and for further education and research in this field.

Keywords: children; chronic urticaria; diagnosis; hives; pediatric; treatment.

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References

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