July 29, 2014
Journal of the American Academy of Dermatology
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This prospective study followed 92 children, aged 4 to 15 years, with chronic urticaria (CU). Food allergy was found in 8.7%, parasitic infestations in 5.4%, and chronic autoimmune urticaria in 40%. Remission rates at 1, 3, and 5 years were 18.5%, 54%, and 68%, respectively. No predictors of CU remission were identified.
There are few prospective studies on CU in children. This study found that CU outcomes are favorable in most children, but there are no known factors predictive of remission.
– Sarah Churton, MD
Written by Sarah L Chamlin MD
Evaluation, treatment, and patient counseling of children with chronic urticaria (CU) and their parents is challenging for practitioners. This large prospective study of 92 children with CU at a tertiary care center in Thailand assessed the natural history and predictors of remission. They report remission rates of 18.5%, 54%, and 67.7% at 1, 3, and 5 years, respectively, after the onset of symptoms. Of course, remission rates might well be higher in a general practice.
This group outlines a systematic approach to evaluation and therapy. Most significantly, they differentiate chronic autoimmune urticaria (CAU) based on a positive autologous serum skin test (ASST), a test rarely used by dermatologists to evaluate patients with CU. This test screens for autoantibodies, especially autoantibodies against high-affinity IgE receptors. The ASST test did not identify a subset of patients who respond differently to treatment nor was this predictive of the clinical course. While, adults with CAU have an increase in a variety of autoimmune diseases, the 37 children in this study demonstrated no autoimmunity based on the ASST test.
BACKGROUND
There are few prospective studies on the natural course of chronic urticaria (CU) in children.
OBJECTIVE
We sought to examine the natural history of CU in children and to identify predictors for remission.
METHODS
Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication.
RESULTS
In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5 years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified.
LIMITATIONS
The basophil histamine release assay was not performed.
CONCLUSION
Children with CU have a favorable outcome. CAU did not have an intractable course.