Pediatric chronic spontaneous urticaria: a brief clinician’s guide

ABSTRACT

Introduction

Chronic urticaria (CU) appears with daily or intermittent/recurrent wheals with/without angioedema for more than six weeks. When no specific eliciting factors are found, chronic urticaria is defined as spontaneous (CSU). Up to 50% of patients with CSU do not respond to therapy, leading to a prolonged disease course and the need for expensive therapies, impacting the quality of life (QoL) and healthcare resources.

Areas covered

Diagnosis of CSU is made when other potential causes of chronic urticaria are excluded. CSU therapy aims to achieve complete control of symptoms and normalization of QoL. Current treatment options for urticaria aim to target mast cell mediators such as histamine, or activators, such as autoantibodies. Guidelines recommend starting with second generation antihistamines (sgAHs) and adding omalizumab therapy if symptoms are not controlled. This review aims to provide a practical guide for CSU in the pediatric population.

Expert opinion

Treatment options for pediatric CSU are primarily based on adult data that have been extrapolated for children. Current guidelines should be reevaluated based on pediatric data, new biological treatments, and the COVID-19 pandemic. Future research is needed to investigate strategies to personalize current treatments and identify potential predictive biomarkers.

KEYWORDS:

• Angioedema
• biological therapy
• biomarkers
• children
• chronic spontaneous urticaria

Article highlights

• Chronic spontaneous urticaria (CSU) severely limits the quality of life; moreover, the absence of an identified cause represents an additional stress factor for patients of any age.

• Diagnosis of CSU requires the exclusions of the most common causes of chronic urticaria; thus, the diagnostic work-up may be long and frustrating for the patients.

• No validated biomarkers are available as predictors of treatment response; however, recent studies identified total serum IgE as the most reliable predictor of omalizumab response in adults.

• Step-up therapy of CSU includes the first-line treatment with sgAHs and, if symptoms are not controlled, omalizumab may be added.

Acknowledgments

M Votto and G Achilli equally reviewed the literature and wrote the manuscript. M De Filippo, A Licari, A Moiraghi, A Marseglia, A Di Sabatino, and G Marseglia, revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript, including the authorship list. The guarantor of the article was G Marseglia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.