1
|
Topkarci Z, Gökçedağ Ünsal G, Can Kuru B, Erdoğan B. Chronic Urticaria in Children: A Single-Center Retrospective Study From Turkey. Clin Pediatr (Phila) 2024:99228241280531. [PMID: 39295534 DOI: 10.1177/00099228241280531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
The studies on childhood chronic urticaria (CU) are limited. We aimed to investigate the epidemiological and etiological factors of children with CU. Demographic characteristics, laboratory findings, and etiological factors of patients diagnosed with CU younger than the age of 18 were retrospectively evaluated. Of the 124 participants, 68 (54.8%) were aged 12 and older. Angioedema accompanied 18.5% of the patients. Chronic spontaneous urticaria (CSU) was found in 75%, while 24.2% had chronic inducible urticaria. Symptomatic dermographism (16.1%) was the most common among chronic inducible urticaria, followed by cholinergic urticaria (4.8%). No etiological factor could be detected in 56.5% of the children. Infections (29.8%) were the most common etiological factor, followed by drugs (8%). Dental problems (16.9%) were the primary infections associated with CU. Chronic urticaria prevalence in children increased with age, with CSU being the most common type. Infections played a significant role in childhood CU.
Collapse
Affiliation(s)
- Zeynep Topkarci
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gizem Gökçedağ Ünsal
- Department of Dermatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burçe Can Kuru
- Department of Dermatology, Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bilgen Erdoğan
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
2
|
Konstantinou GN, Konstantinou GN. Psychiatric comorbidities in children and adolescents with chronic urticaria. World J Pediatr 2023; 19:315-322. [PMID: 36376557 DOI: 10.1007/s12519-022-00641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic urticaria (CU) has been shown to impact patients' quality of life negatively and may coexist with psychiatric disorders. We systematically reviewed the published evidence of comorbid psychiatric disorders in children and adolescents with CU. METHODS A systematic review of studies published until February 2022 in PubMed, Google Scholar, and Scopus was performed. An a priori set of inclusion criteria was predefined for the studies to be included: (1) clear distinction between urticaria and other allergies; (2) precise distinction between acute and CU; (3) participants younger than 18 years old, exclusively; (4) use of appropriate standardized questionnaires, psychometric tools, and standard diagnostic nomenclature for the mental health and behavioral disorders diagnosis; and (5) manuscripts written or published in the English language. RESULTS Our search identified 582 potentially relevant papers. Only eight of them satisfied the inclusion criteria. Quantitative meta-analysis was not deemed appropriate, given the lack of relevant randomized control trials, the small number of relevant shortlisted, the small sample size of the patients included in each study, and the remarkable heterogeneity of the studies' protocols. CONCLUSIONS The included studies suggest an increased incidence of psychopathology among children and adolescents with CU as opposed to healthy age-matched individuals, but the data are scarce. Further research is required to clarify whether psychopathology is just a comorbid entity, the cause, or the consequence of CU. Meanwhile an interdisciplinary collaboration between allergists/dermatologists and psychiatrists is expected to substantially minimize CU burden and improve patients' quality of life.
Collapse
Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloníki, Greece.
| | - Gerasimos N Konstantinou
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| |
Collapse
|
3
|
Örsten S, Baysal İ, Akdoğan N, İnal N, Bostan E, Çiftçi SY, Akyön Y. Possible microRNA-based mechanism underlying relationship between chronic spontaneous urticaria and Blastocystis. Exp Parasitol 2023; 245:108453. [PMID: 36584787 DOI: 10.1016/j.exppara.2022.108453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Blastocystis spp. has been proposed as a possible cause of extraintestinal clinical signs such as urticaria pathogenesis. OBJECTIVES The aim of this study was to investigate the differences between microRNA (miRNA) expression profiles of Chronic spontaneous urticaria (CSU) patients in the presence or absence of Blastocystis spp. as well as healthy controls. Additionally, cellular pathways which are affected in the presence of Blastocystis spp. were identified. METHODS Twenty patients diagnosed with CSU were enrolled in the study and divided into equally two groups according to the presence of Blastocystis spp. Besides, six healthy individuals were included in the study. The expression profiles of 372 human-derived miRNAs have been investigated in serum samples from CSU patients and healthy controls with miScript miRNA PCR Array Human miRBase Profiler. RESULTS Compared to Blastocystis-negative (BN)-CSU patients, expression of 3 miRNAs (hsa-miR-3183, hsa-miR-4469, hsa-miR-5191) were found to be downregulated by at least two-fold (p < 0.05) in Blastocystis-positive (BP)-CSU patients. Additionally, the miRNA expression profiles of six healthy individuals (n = 3 Blastocystis-positive, n = 3 Blastocystis-negative) were analyzed and it was determined that the expressions of 7 miRNAs (hsa-miR-4661-5p, hsa-miR-4666a-5p, hsa-miR-4803, hsa-miR-5587-5p, hsa-miR-4500, hsa-miR-5680, hsa-miR-382-3p) increased at least 3-fold in the serum of individuals with Blastocystis-positive compared to Blastocystis-negative subjects. Most down-regulated miRNAs, in BP-CSU patients, affect cell adhesion molecules (CAMs), and signaling pathways therefore, Blastocystis spp. presence may influence the clinical presentation of urticaria by leading to unbalanced immunity. In addition, Blastocystis spp. presence may be influenced TGF- β signaling pathway through altered miRNAs and may be laying the groundwork for the development of CSU in healthy individuals. CONCLUSIONS As a consequence, this is the first report to show that the miRNA expression profile is affected by the presence of Blastocystis spp. Further miRNA-based studies are needed in order to enlighten the exact underlying molecular mechanisms of the relationship between Blastocystis spp. and CSU.
Collapse
Affiliation(s)
- Serra Örsten
- Hacettepe University, Vocational School of Health Services, Ankara, Turkey.
| | - İpek Baysal
- Hacettepe University, Vocational School of Health Services, Ankara, Turkey
| | - Neslihan Akdoğan
- Hacettepe University, Faculty of Medicine Department of Dermatology and Venereology, Ankara, Turkey
| | - Neşe İnal
- Hacettepe University, Faculty of Medicine Department of Medical Microbiology, Ankara, Turkey
| | - Ecem Bostan
- Hacettepe University, Faculty of Medicine Department of Dermatology and Venereology, Ankara, Turkey
| | | | - Yakut Akyön
- Hacettepe University, Faculty of Medicine Department of Medical Microbiology, Ankara, Turkey
| |
Collapse
|
4
|
Panda M, Agarwal A, Jena A, Dash M. Efficacy and safety of autologous serum therapy in chronic spontaneous urticaria in the pediatric population: A prospective pilot study. Indian Dermatol Online J 2023; 14:195-199. [PMID: 37089855 PMCID: PMC10115325 DOI: 10.4103/idoj.idoj_376_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 03/12/2023] Open
Abstract
Background Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. Objectives To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. Materials and Methods All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Results Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. Conclusion This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.
Collapse
|
5
|
Zhang C, Wei Y. Association Between Helicobacter pylori-Negative Peptic Ulcer Disease and Chronic Urticaria: A Retrospective Observational Study. Clin Cosmet Investig Dermatol 2021; 14:1637-1643. [PMID: 34785922 PMCID: PMC8591315 DOI: 10.2147/ccid.s336617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
Objective The association between peptic ulcer disease (PUD) and chronic urticaria (CU) is rarely examined in individuals without Helicobacter pylori infection. The study aimed to investigate the association between Helicobacter pylori-negative PUD and CU. Methods Patients without Helicobacter pylori infection were retrospectively enrolled from those who visited the clinic or were admitted to the ward of the dermatological department with recent gastroscopy and Helicobacter pylori testing in a tertiary hospital between 2015 and 2019. After categorizing them as patients with and without PUD, we used propensity score matching to identify a cohort of PUD and a control cohort at a ratio of 1:2. CU was determined by examining medical records of the two cohorts, and logistic regression analyses were used to evaluate the association between PUD and CU with or without adjusting for covariates. Results We included 40 patients with PUD as the PUD cohort and 80 patients without PUD as the control cohort, between which there were no significant differences in patient characteristics, including age, sex, and several comorbidities (P all >0.05). Among the PUD cohort, 25.00% (10/40) of them were with CU, which was significantly higher than that in the control cohort 8.75% (7/80, P = 0.016). Results of logistic regression analyses showed PUD was significantly associated with increased risk of CU (odds ratio (OR) 3.48, 95% confidence interval (CI) 1.21–9.99, P = 0.021), which was consistent with that after adjusted for potential confounding factors (OR 3.77, 95% CI 1.24–11.45, P = 0.019). Conclusion Helicobacter pylori-negative PUD is associated with increased risk of CU.
Collapse
Affiliation(s)
- Chengguo Zhang
- Department of Dermatology, Hanchuan People's Hospital, Hanchuan, 431600, People's Republic of China
| | - Yinbin Wei
- Department of Infectious Diseases, Hanchuan People's Hospital, Hanchuan, 431600, People's Republic of China
| |
Collapse
|
6
|
Lachover-Roth I, Rabie A, Cohen-Engler A, Rosman Y, Meir-Shafrir K, Confino-Cohen R. Chronic urticaria in children - New insights from a large cohort. Pediatr Allergy Immunol 2021; 32:999-1005. [PMID: 33502063 DOI: 10.1111/pai.13457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. METHODS This retrospective study followed children up to 18 years old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018, and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments, and outcomes were extracted from electronic medical records. RESULTS Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, and 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25 ± 15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2%, and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. CONCLUSIONS AND CLINICAL RELEVANCE Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population, increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.
Collapse
Affiliation(s)
- Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Rabie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Cohen-Engler
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Meir-Shafrir
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Kouotou EA, Nansseu JRN, Tounouga DN, Otsali Noa RK, Ndjitoyap Ndam EC. Knowledge, attitudes, and practices associated with personal health care on urticaria in peripheral health facilities of Yaoundé, Cameroon (Sub-Saharan Africa). Int J Dermatol 2021; 60:1224-1231. [PMID: 34101834 DOI: 10.1111/ijd.15681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urticaria is an acute or chronic inflammatory dermatosis that is characterized by erythematous, edematous, itchy, and transient urticarial plaques that cover the skin and mucous membranes. The aim of this study was to evaluate the knowledge of consulting staff on urticaria in Yaoundé, Cameroon, as well as the attitudes and practices resulting from it. METHODS We conducted a descriptive cross-sectional study. The participants were enrolled from January to April 2017 in 25 health facilities in Yaoundé, Cameroon. The sample consisted of health personnel including doctors, nurses, and nursing aids. Data were collected using a self-administered questionnaire; the evaluation scores for each heading were established. Data processing was done using the SPSS software Version 21. RESULTS We recruited 101 participants, with a sex ratio of 0.4 (73/101 were female); 44.6% of the participants were doctors, and 50% of our participants had less than 5 years of professional experience. The level of knowledge on urticaria was insufficient for 40.6% of the staff enrolled. Attitudes towards urticaria were incorrect for 36.6% of staff, and 95% of our sample had harmful practices. CONCLUSION Our study reveals that skills of the health care provider regarding urticaria are generally poor and do not enable them to ensure an adequate management of the disease.
Collapse
Affiliation(s)
- Emmanuel Armand Kouotou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Jobert Richie N Nansseu
- Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Raissa Katy Otsali Noa
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Elie Claude Ndjitoyap Ndam
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| |
Collapse
|
8
|
Fakhar M, Ghaffari J, Dabbaghzadeh A, Charati JY, Ghaffari B, Esboei BR. Prevalence of Intestinal Parasites among Patients with Chronic Urticaria in Northern Iran. Infect Disord Drug Targets 2021; 21:130-133. [PMID: 32342822 DOI: 10.2174/1871526520666200428095729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/15/2019] [Accepted: 03/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic urticaria (CU) has a range of clinical demonstrations and causes. Parasitic infections are mentioned as one of the main causes of the CU. OBJECTIVES The aim of this study was to investigate the prevalence of intestinal parasites in patients with CU (with duration time of more than 6 weeks) compared healthy subjects. METHODS A total of 169 cases and 210 controls were included in this study. Ages ranged from 1 to 77 years old. Three samples were gathered from each patients and direct wet mount, formol-ether concentration, Ziehl-Neelsen and trichrome staining were used. RESULTS Out of the 379 individuals examined here, 208 were from urban areas and 171 from rural areas. Three stool samples were taken from each patient in three consecutive days. Based on parasitological tests, 7 (4.1%) cases from 169 patients with CU and 6 (2.9%) cases from 210 non- CU group individuals were positive for intestinal parasites. CONCLUSION The prevalence of various parasites between case and control groups was not significant.
Collapse
Affiliation(s)
- Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Ghaffari
- Pediatric Infectious Diseases Research Center, Mazandaran University of medical sciences, Sari, Iran
| | - Abbas Dabbaghzadeh
- Pediatric Infectious Diseases Research Center, Mazandaran University of medical sciences, Sari, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Bahman Ghaffari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Bahman Rahimi Esboei
- Department of Parasitology and Mycology, Tonekabon Branch, Faculty of Medicine, Islamic Azad University, Tonekabon, Iran
| |
Collapse
|
9
|
Chang J, Cattelan L, Ben-Shoshan M, Le M, Netchiporouk E. Management of Pediatric Chronic Spontaneous Urticaria: A Review of Current Evidence and Guidelines. J Asthma Allergy 2021; 14:187-199. [PMID: 33727832 PMCID: PMC7955742 DOI: 10.2147/jaa.s249765] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022] Open
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.
Collapse
Affiliation(s)
- Jasmine Chang
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Leila Cattelan
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Nieto A, Nieto M, Mazón Á. The clinical evidence of second-generation H1-antihistamines in the treatment of allergic rhinitis and urticaria in children over 2 years with a special focus on rupatadine. Expert Opin Pharmacother 2020; 22:511-519. [PMID: 33198523 DOI: 10.1080/14656566.2020.1830970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Many obstacles limit the development of pharmacologic studies in children, in particular ethical and practical issues. Therefore, although second-generation H1-antihistamines (sgAH) are recommended by international guidelines as first-line therapy in childhood allergies, most data on the efficacy of antihistamines in children has been extrapolated from studies in adult patients. AREAS COVERED The current review focuses on rupatadine, a well-studied modern sgAH that has dual affinity for histamine H1-receptors and PAF receptors. In recent years, clinical efficacy and safety controlled-clinical trials on rupatadine were conducted in children and were based on latest current guidelines using validated tools of allergic rhinitis and urticaria. EXPERT OPINION Children are not little adults since they present specific physiologic, metabolic, and developmental differences that should be evaluated in specific trials. The clinical evidence with rupatadine in children is the most recent and validated in accordance with current recommendations, with extensive direct data on efficacy and safety in pediatric populations over 2 years old.
Collapse
Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, Valencia, Spain
| | - María Nieto
- Allergy Service, Hospital De La Plana, Villarreal, Castellón, Spain
| | - Ángel Mazón
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, Valencia, Spain
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To review recent evidence on the association of urticaria and the gut diseases, focusing on the roles of chronic inflammation with or without Helicobacter pylori (H. Pylori) infection. RECENT FINDINGS The connection between the gut and urticaria has been discussed for a long time. Some publications have shown that H. pylori can induce chronic spontaneous urticaria (CSU). Recently, it was reported that upper gastrointestinal inflammatory disorders can cause CSU and trigger exacerbations independently of H. pylori. SUMMARY Gastritis and especially H. pylori-induced gastritis has been implicated as potential trigger of CSU. Chronic parasite infection and inflammation of the gut are relevant comorbidities and also potential inducing factors for the development of urticaria.
Collapse
|
12
|
Ozceker D, Dilek F, Yucel E, Tamay Z, Ozkaya E, Guler N. Can allergy patch tests with food additives help to diagnose the cause in childhood chronic spontaneous urticaria? Postepy Dermatol Alergol 2020; 37:384-389. [PMID: 32792880 PMCID: PMC7394169 DOI: 10.5114/ada.2020.96909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/24/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) is characterized by the onset of symptoms which are not induced by specific triggers, but are rather spontaneous. A considerable number of patients report that foods or food additives might be responsible for their chronic urticaria. AIM To determine the prevalence of sensitization to food additives in children with CSU using atopy patch tests (ATP). MATERIAL AND METHODS Atopy patch tests for 23 different food additives were applied to 120 children with CSU and 61 healthy controls. RESULTS Seventeen (14.1%) children with CSU were sensitized with food additives. None of the control group had positive APT. Azorubine and Cochineal red were the food additives detected with the highest sensitization rates (5.8% (n = 7) and 6.7% (n = 8), respectively). CONCLUSIONS There can be an association between food additives and CSU. APT tests may be a helpful tool in the assessment and management of CSU so that easier to follow diets and effective treatments can be offered to families.
Collapse
Affiliation(s)
- Deniz Ozceker
- Department of Paediatric Allergy and Immunology, Saglik Bilimleri University, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Fatih Dilek
- Department of Paediatric Allergy and Immunology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - Esra Yucel
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zeynep Tamay
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Emin Ozkaya
- Department of Paediatric Allergy and Immunology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - Nermin Guler
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
- Department of Paediatrics, Medical Faculty, Istanbul Bilim University, Istanbul, Turkey
| |
Collapse
|
13
|
Nisticò D, Passanisi S, Oppedisano EM, Caminiti L, Marino A, Ruggeri P, Crisafulli G, Pajno GB. Direct drug provocation test for the diagnosis of self-reported, mild and immediate drug hypersensitivity reaction in children and adolescents: our real-life experience. Minerva Pediatr (Torino) 2020; 73:209-214. [PMID: 32418402 DOI: 10.23736/s2724-5276.20.05710-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Approximately 10% of the parents report suspected drug hypersensitivity reactions to at least one drug in their children, but most of these reactions are not confirmed after an adequate diagnostic work-up. The diagnosis of drugs hypersensitivity is frequently laborious and based on anamnesis, skin tests, serum specific IgE research and drug provocation test. Nevertheless, drug provocation test is necessary to confirm or definitively exclude the diagnosis of allergy. Aims of our study were to evaluate the real incidence of drug hypersensitivity in a large pediatric population and the validity of a short diagnostic algorithm. METHODS One hundred nine patients with a history of self-reported, immediate and mild drug hypersensitivity reactions to β-lactam antibiotics, macrolides and non-steroidal anti-inflammatory drugs underwent drug provocation test without prior skin or blood tests. After one-year, a telephone questionnaire was conducted in order to evaluate patient's use of the tested drug and any reactions. RESULTS Only 7 of the 109 patients (6.4%) resulted positive to drug provocation test. No severe reactions were reported. After the challenge, 64 patients took the culprit drug again within one year and only two reported a drug reaction. CONCLUSIONS Drug hypersensitivity is highly overestimated. Our results prompt the opportunity to directly perform the challenge for those children with self-reported, mild and immediate drug hypersensitivity reaction.
Collapse
Affiliation(s)
- Daniela Nisticò
- Department of Pediatric, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy
| | - Stefano Passanisi
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy -
| | - Erminia M Oppedisano
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Lucia Caminiti
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Alessandra Marino
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Paolo Ruggeri
- Unit of Pneumology, Department of Biomedical, Dental and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Crisafulli
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Giovanni B Pajno
- Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| |
Collapse
|
14
|
Williams PV. Pharmacologic Management of Chronic Urticaria in Pediatric Patients: The Gap Between Guidelines and Practice. Paediatr Drugs 2020; 22:21-28. [PMID: 31858489 DOI: 10.1007/s40272-019-00365-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic urticaria is an uncommon disorder in children but can present considerable morbidity, as well as frustration for the healthcare provider and parent. The prevalence is 0.1-0.3% but can vary considerably by country. Chronic spontaneous urticaria (no identifiable cause) is responsible for 70-80% of chronic urticaria, about half of this due to a subtype called chronic autoimmune urticaria identified by the presence of autoantibodies to IgE or the IgE receptor. Chronic urticaria that is triggered by external physical stimuli is called chronic inducible urticaria and is present in another 15-20%. Allergies, infection, and other underlying diseases such as thyroid disease, celiac disease, or Helicobacter pylori infection cause a minor proportion of cases. Chronic urticaria has considerable impact on quality of life and healthcare costs. An adverse impact on quality of life is more prevalent in older children and adolescents and can be comparable to other diseases of childhood such as diabetes and epilepsy. Healthcare costs can be 50% higher than the national estimates for healthy patients and include more hospitalizations, longer duration of hospitalizations, and more emergency department (ED) and outpatient visits. Allergic and autoimmune diseases can be comorbidities that add to healthcare utilization. Resolution can take years. Guidelines are available for diagnosis and treatment. A good history is the key to identifying the cause. Minimal laboratory tests are required and should be guided by the history. Patients with easily controlled urticaria may not need any laboratory tests. Suggested treatment emphasizes the use of non-sedating antihistamines, utilized in a step-wise fashion beginning with normal doses and advancing the dose based on the response up to four times the recommended dose for age. Other treatments are left to the urticaria specialist and are not discussed in this paper. These guidelines are not well utilized based on real-world studies; sedating antihistamines and oral steroids are overutilized. Medications should be taken daily, not as needed. Additional medications, if required, should be added to prior medications in a step-wise fashion. The gap between the guidelines for diagnosis and treatment and what is happening in the real world needs to be closed to reduce the cost and morbidity associated with this disorder.
Collapse
Affiliation(s)
- Paul V Williams
- Department of Pediatrics, Allergy Division, University of Washington School of Medicine, Seattle, WA, USA. .,Northwest Asthma & Allergy Center, 10333 19th Ave SE, Suite 105, Everett, WA, 98208, USA.
| |
Collapse
|
15
|
Hardman SJ, Minshall E. Fifteen-minute consultation: Assessing the child with persistent urticaria. Arch Dis Child Educ Pract Ed 2020; 105:7-12. [PMID: 31048341 DOI: 10.1136/archdischild-2018-315878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/22/2019] [Accepted: 03/07/2019] [Indexed: 11/03/2022]
Abstract
Chronic urticaria is the presence of wheals and/or angioedema, with daily or intermittent symptoms lasting more than 6 weeks. Although rarely life threatening, it can be a cause of significant embarrassment and misery. In most cases, no underlying factor is identified. It is therefore important to have a structured approach to the assessment in order to exclude important diagnoses, minimise costly screening tests and ensure a correct diagnosis is made. This article aims to highlight the importance of a focused history, provides a clear scheme for establishing a diagnosis and recommends when to perform appropriate investigations. A short discussion regarding treatment options and prognosis is also provided.
Collapse
Affiliation(s)
| | - Eleanor Minshall
- Paediatric allergy department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
16
|
Bansal CJ, Bansal AS. Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2019; 15:56. [PMID: 31528163 PMCID: PMC6737621 DOI: 10.1186/s13223-019-0372-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.
Collapse
|
17
|
Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
| |
Collapse
|
18
|
Rosman Y, Hershko AY, Meir-Shafrir K, Kedem R, Lachover-Roth I, Mekori YA, Confino-Cohen R. Characterization of chronic urticaria and associated conditions in a large population of adolescents. J Am Acad Dermatol 2019; 81:129-135. [PMID: 30797847 DOI: 10.1016/j.jaad.2019.02.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although chronic spontaneous urticaria (CSU) affects all age groups, data regarding CSU in adolescents is scarce. OBJECTIVE To characterize the epidemiology, demographics, and comorbidities associated with CSU in a large, cross-sectional nationwide population of adolescents. METHODS Medical records of 16-year-old candidate conscripts to the Israeli Defense Forces were reviewed. Data were collected on the prevalence and severity of CSU, as well as the demographics, medical comorbidities, medication use, and blood test results of affected individuals. RESULTS Medical records of 1,108,833 consecutive 16-year-old adolescents were reviewed. A total of 6617 (0.6%) adolescents received CSU diagnoses. CSU was increased in female conscripts (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.07-1.19, P < .001) and adolescents with higher socioeconomic scores (OR 1.92, 95% CI 1.56-2.32, P < .001). Individuals with CSU were significantly more likely to have allergic diseases, including food allergy (OR 7.31, 95% CI 6.13-8.72), allergic rhinitis (OR 2.9, 95% CI 2.71-3.11), atopic dermatitis (OR 2.35, 95% CI 2.03-2.72), and asthma (OR 1.46, CI 1.35-1.57). CONCLUSION Our work provides an account of CSU in a large cohort of adolescents. We found a strong link between CSU and atopic diseases. Further investigation is needed to decipher the mechanism underlying this observed association.
Collapse
Affiliation(s)
- Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Alon Y Hershko
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren Meir-Shafrir
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel
| | - Ron Kedem
- Medical Corps Headquarters, Israel Defense Forces, Tel HaShomer, Israel
| | - Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoseph A Mekori
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
19
|
Kudryavtseva AV, Neskorodova KA, Staubach P. Urticaria in children and adolescents: An updated review of the pathogenesis and management. Pediatr Allergy Immunol 2019; 30:17-24. [PMID: 30076637 DOI: 10.1111/pai.12967] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022]
Abstract
The present survey represents the latest data on diagnosis and management of childhood urticaria. It has been observed that urticaria occurs less often in children than adults, with symptoms rarely lasting for over 6 weeks. Triggers or aggravating factors can be found only in 21%-55% of cases. Finding autoantibodies in children does not impact a disease prognosis, unlike in adult patients, where the presence of autoantibodies is associated with a more prolonged run of the disease, a more severe prognosis and more intensive treatment methods. The incidence of food allergy equals to 8%-10% of cases. The incidence of Helicobacter Pylori infection in children is lower than that in adults and comes to 10%-18%. Medical experts recommend using the same treatment schemes for adults and children. This survey describes different urticaria management patterns suggested by experts from Europe, America, and Russia in their recent guidelines. It has been noted that unlike the guidelines from 2014, the 2018 clinical practice guidelines for the diagnosis and management of urticarial once again suggest a four-step treatment scheme with assigning omalizumab for Step 3 and cyclosporine A for Step 4 in the event of low therapeutic efficacy of the previous step or its impossibility. Leukotriene antagonists (LTRAs) are currently removed from basic management to alternative programs.
Collapse
Affiliation(s)
| | | | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| |
Collapse
|
20
|
Mastrorilli C, Bernardini R, Liotti L, Franceschini F, Crisafulli G, Caimmi S, Bottau P, Mori F, Cardinale F, Saretta F, Simeone G, Bergamini M, Caffarelli C. Chronic urticaria and drug hypersensitivity in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:61-65. [PMID: 30830063 PMCID: PMC6502169 DOI: 10.23750/abm.v90i3-s.8166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/12/2022]
Abstract
The cause of chronic urticaria remains often elusive. The association between chronic urticaria and intake of medications have been reported in children. However, the causative role of drugs has been rarely ascertained by onset of symptoms on drug provocation test. Chronic urticaria can be mediated by immunologic and nonimmunologic mechanisms. The diagnostic work-up of chronic urticaria includes a comprehensive evaluation of triggering factors such as drugs. A diagnosis is necessary in order to permit a safely administration of drugs in children with chronic urticaria.
Collapse
Affiliation(s)
- Carlo Mastrorilli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Azienda Ospedaliero-Universitaria, Università di Parma, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mori F, Caffarelli C, Caimmi S, Bottau P, Liotti L, Franceschini F, Cardinale F, Bernardini R, Crisafulli G, Saretta F, Novembre E. Drug reaction with eosinophilia and systemic symptoms (DRESS) in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:66-79. [PMID: 30830064 PMCID: PMC6502175 DOI: 10.23750/abm.v90i3-s.8167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe reaction to drugs. Incidence of DRESS in children is not well known and the mortality rate seems to be lower than 10%. Anticonvulsants are the main drugs involved both in adults and in children. The treatment of choice is intravenous immunoglobulins and corticosteroids used in synergy. Today there are not controlled clinical trials regarding DRESS treatment in children. Anyway, the prompt withdrawn of the offending drug is of paramount importance for a better prognosis. DRESS sequels may occur, consequently, follow-up visits are required at least until the first year after the reaction. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Calamelli E, Caffarelli C, Franceschini F, Saretta F, Cardinale F, Bernardini R, Liotti L, Mori F, Crisafulli G, Caimmi S, Bottau P. A practical management of children with antibiotic allergy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:11-19. [PMID: 30830057 PMCID: PMC6502179 DOI: 10.23750/abm.v90i3-s.8157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
About 10% of the parents reported that their children are allergic to one drug and the betalactam antibiotics are the most frequently suspected. Even if most of the adverse events following antibiotic prescriptions to children are considered allergic, after a full allergy work-up only a few of the suspected reactions are confirmed. For this reason, many children are incorrectly labelled as "allergic" and this represents an important challenge for the choice of the antibiotic therapy in these "labelled" children, who are frequently improperly deprived of narrow-spectrum antibiotics because considered as allergic. When an allergic reaction is suspected a precise diagnosis and a choice of a safe and effective alternative is essential for the future antibiotic option. In the light of this, the main aim of this paper is to try to provide a practical approach to managing the individuals who have reported adverse reactions to antibiotics.
Collapse
|
23
|
Caimmi S, Caffarelli C, Saretta F, Liotti L, Crisafulli G, Cardinale F, Bottau P, Mori F, Franceschini F, Bernardini R, Marseglia GL. Drug desensitization in allergic children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:20-29. [PMID: 30830058 PMCID: PMC6502172 DOI: 10.23750/abm.v90i3-s.8158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/25/2022]
Abstract
Drug allergy is an increasing problem worldwide, affecting all populations and races, children and adults, and for which diagnosis and treatment are not well standardized yet. Besides classical treatments, new drugs have been developed, especially for patients suffering from malignancies and chronic inflammatory diseases, that specifically target the cause of the disease. For those patients requiring such molecules, it is sometimes difficult to find an alternative drug when hypersensitivity reactions occur. Desensitization is therefore the best option whenever no alternative therapy is available but also when alternative treatments are considered therapeutically inferior and or more toxic. Despite its clinical success, little is known about the mechanisms and molecular targets of drug desensitization. Desensitization protocols use a gradual dose escalation to allow the safe administration of a treatment to which a patient previously presented a hypersensitivity reaction. The procedure requires special training and coordination of an allergy team, including physicians, nurses, and pharmacists, working together to safely and successfully implement desensitization protocols when appropriate. There is no difference in desensitization protocol between adults and children, except for the final cumulative dose of the administered drug.
Collapse
Affiliation(s)
- Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
[Age-specific aspects in the treatment of angioedema patients]. Hautarzt 2019; 70:101-106. [PMID: 30656381 DOI: 10.1007/s00105-018-4346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Manifestation of angioedema can occur at any age. We distinguish between two main subtypes: mast cell mediator-associated angioedema (often with hives) and the non-mast cell mediator-associated angioedema. The patient's history is very important due to the fact that one subtype can be hereditary, but we also have to consider new mutations and even not yet diagnosed patients. Acquired non-mast cell mediator-associated angioedema is rare in children, but very common in adults due to the intake of angiotensin-converting enzyme inhibitors. From a detailed anamneses, classification is very often possible. But especially in childhood, symptoms are often projected onto the gastrointestinal tract, which have to be seen differently. The burden of disease defined as disease activity and quality of life may change in the course of life, but is not always predictable. Therapies are available for all angioedema subtypes in any age. If treatment is necessary, the attacks should be treated early to positively influence duration and severity of the attacks. The management of the patients includes besides information, education of the patient and family members regarding therapy options and prevention of triggers and the repetition of education, especially in case of any change of life circumstances.
Collapse
|
25
|
Sirufo MM, Ginaldi L, De Martinis M. Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report. Front Pediatr 2019; 7:213. [PMID: 31275903 PMCID: PMC6593296 DOI: 10.3389/fped.2019.00213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/10/2019] [Indexed: 12/14/2022] Open
Abstract
Childhood urticaria is not rare, although its persistence is less frequent. In children, chronic spontaneous urticaria (CSU) is associated with comorbidities, including asthma, allergic rhinitis, or atopic dermatitis, and many children with CSU have a family history of atopy. The therapeutic approach to CSU in children is the same one recommended by international guidelines for treatment of chronic urticaria in adults. In the European Union, according to the European Medicine Agency, omalizumab is the add-on drug of choice for the management of CSU in adult and adolescent patients (from 12 years of age) with inadequate response to H1 antihistamine therapy. In addition, in children (6 to <12 years of age), it is the add-on therapy of choice to improve asthma control. The management of children with urticaria under 12 is a therapeutic area with few certainties, where omalizumab can be administered only "off-label."
Collapse
Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, Department of Medicine, AUSL 04, Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, Department of Medicine, AUSL 04, Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, Department of Medicine, AUSL 04, Teramo, Italy
| |
Collapse
|
26
|
Caffarelli C, Franceschini F, Caimmi D, Mori F, Diaferio L, Di Mauro D, Mastrorilli C, Arasi S, Barni S, Bottau P, Caimmi S, Cardinale F, Comberiati P, Crisafulli G, Liotti L, Pelosi U, Saretta F, Marseglia G, Duse M, Paravati F. SIAIP position paper: provocation challenge to antibiotics and non-steroidal anti-inflammatory drugs in children. Ital J Pediatr 2018; 44:147. [PMID: 30526636 PMCID: PMC6286516 DOI: 10.1186/s13052-018-0589-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022] Open
Abstract
Drug hypersensitivity reactions (DHRs) in childhood are mainly caused by betalactam or non-betalactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs). Laboratory tests for identifying children who are allergic to drugs have low diagnostic accuracy and predictive value. The gold standard to diagnose DHR is represented by the drug provocation test (DPT), that aims of ascertaining the causative role of an allergen and evaluating the tolerance to the suspected drug. Different protocols through the administration of divided increasing doses have been postulated according to the type of drug and the onset of the reaction (immediate or non immediate reactions). DPT protocols differ in doses and time interval between doses. In this position paper, the Italian Pediatric Society for Allergy and Immunology provides a practical guide for provocation test to antibiotics and NSAIDs in children and adolescents.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43122 Parma, Italy
| | | | - Davide Caimmi
- Allergy Unit, Departement de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Francesca Mori
- Allergy Unit, Department of Pediatric, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Lucia Diaferio
- Department of Paediatrics, Aldo Moro University of Bari-Giovanni XXIII Hospital, Bari, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43122 Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43122 Parma, Italy
| | - Stefania Arasi
- Pediatric Allergy Unit, Bambino Gesù Academic Hospital, Rome, Vatican State Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatric, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Paolo Bottau
- Department of Paediatrics and Neonatology, Ospedale di Imola, Azienda USL, Imola, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Department of Pediatrics, University of Pavia, Pavia, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital “Giovanni XXIII”, University of Bari, Bari, Italy
| | - Pasquale Comberiati
- Pediatric Clinic, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Giuseppe Crisafulli
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Lucia Liotti
- Pediatric Unit, Civic Hospital, Senigallia, Italy
| | | | | | - Gianluigi Marseglia
- Pediatric Clinic, University of Pavia, IRCCS Policlinico “S. Matteo” Foundation, Pavia, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesco Paravati
- Pediatric Unit, Infant Maternal Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| |
Collapse
|
27
|
Erythroderma and Figurate Erythemas. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Caffarelli C, Di Mauro D, Mastrorilli C, Bottau P, Cipriani F, Ricci G. Solid Food Introduction and the Development of Food Allergies. Nutrients 2018; 10:E1790. [PMID: 30453619 PMCID: PMC6266759 DOI: 10.3390/nu10111790] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
The rise of food allergy in childhood, particularly among developed countries, has a significant weight on public health and involves serious implications for patients' quality of life. Even if the mechanisms of food tolerance and the complex interactions between the immune system and environmental factors are still mainly unknown, pediatricians have worldwide implemented preventive measures against allergic diseases. In the last few decades, the prevention of food allergy has tracked various strategies of complementary feeding with a modification of international guidelines from delayed introduction to early weaning. Current evidence shows that complementary foods, including allergenic ones, should be introduced into diet after four months, or even better, following World Health Organization advice, around six months irrespective of risk for allergy of the individual. The introduction of peanut is recommended before 12 months of age among infants affected by severe eczema and/or egg allergy to diminish the occurrence of peanut allergy in countries with high peanut consumption. The introduction of heated egg at 6⁻8 months of age may reduce egg allergy. Infants at high risk of allergy similarly to healthy children should introduce complementary foods taking into account family and cultural preferences.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Dora Di Mauro
- Clinica Pediatrica Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Carla Mastrorilli
- Clinica Pediatrica Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Paolo Bottau
- Pediatria, Azienda Ospedaliera di Imola, Via Montericco 4, 40026 Imola, Italy.
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy.
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy.
| |
Collapse
|
29
|
Kumaran MS, Mahajan R, Goyal N, Parsad D. Clinico-epidemiological features of chronic urticaria in children: A retrospective analysis of 296 children from a tertiary care institute in Northern India. Indian J Dermatol Venereol Leprol 2018; 86:50-54. [PMID: 30264742 DOI: 10.4103/ijdvl.ijdvl_573_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered, however, epidemiologic data on pediatric urticaria are limited. Aim The objective of this study was to study the clinico-epidemiological profile of children with chronic urticaria. Methods A retrospective study including children less than 14 years with chronic urticaria was conducted from January 2010 to December 2015. Detailed history, clinical examination, investigation results, treatment taken, and follow-up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders. Results Two hundred and ninety-six children (166 boys, 130 girls; mean age, 11.3 years) with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 57.1% (169) children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in 48 (16.2%) patients; Antinuclear antibody was negative in all patients, raised serum IgE in 20/48 (41.6%), positive autologous serum skin test in 32/48 (66.6%) and raised anti-TPO titre in 10/48 (20.8%) children. A diagnosis of chronic spontaneous urticaria was made in 245 (82.77%) children, chronic dermographic urticaria in 35 (11.82%), cholinergic urticaria and drug-induced urticaria in 5 (1.69%) each, aquagenic urticaria in 4 (1.35%) and cold-induced urticaria in 2 (0.68%) children. Two hundred and fifteen (72.6%) children responded to nonsedating antihistamines alone, 61 (20.6%) required addition of a sedating antihistamine, 7 (0.02%) required addition of montelukast, 3 (0.01%) ranitidine and 10 (20.8%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long-term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months. Limitations The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated. Conclusions Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long-term antihistamines.
Collapse
Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nupur Goyal
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
30
|
Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G. Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr 2018; 44:82. [PMID: 30016966 PMCID: PMC6050676 DOI: 10.1186/s13052-018-0524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda Ospedaliera-Universitaria, Parma, Italy
| | - Giuliana Valerio
- Pediatria, Dipartimento di Scienze Motorie e del Benessere, Università di Napoli Parthenope, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Mariella Valenzise
- UOC Clinica Pediatrica AOU G, Martino Università di Messina, Messina, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| |
Collapse
|
31
|
Yaşar E, Öztürk Kara D, Yıldırım N. A Case of Allergic Urticaria After Ophthalmic Nepafenac Use. Turk J Ophthalmol 2018; 48:146-149. [PMID: 29988879 PMCID: PMC6032958 DOI: 10.4274/tjo.78614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022] Open
Abstract
A 21-year-old male patient with no history of systemic disease or drug use presented to our clinic with redness and pain in the right eye. Best corrected visual acuity was 20/20 in both eyes. Inflamed pinguecula was observed on slit-lamp examination and the patient was prescribed ophthalmic nepafenac eye drops. After instilling the drops that day and the next day, the patient presented again due to pruritus and rash. Upon consultation with the dermatology department, the patient was diagnosed with drug-induced allergic urticaria and the nepafenac drops were discontinued. Although urticaria has been reported as a side effect after systemic non-steroidal anti-inflammatory drug (NSAID) use, such a reaction has not been reported with an ophthalmic NSAID and ours is the first reported case of urticaria following ophthalmic nepafenac use. This unique case highlights the fact that ophthalmologists must also keep urticaria in mind as a potential side effect when prescribing this drug.
Collapse
Affiliation(s)
- Erdoğan Yaşar
- Aksaray University Aksaray Training and Research Hospital, Ophthalmology Clinic, Aksaray, Turkey
| | - Deniz Öztürk Kara
- Aksaray University Aksaray Training and Research Hospital, Dermatology Clinic, Aksaray, Turkey
| | - Nilgün Yıldırım
- Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| |
Collapse
|
32
|
Ben-Shoshan M, Grattan CE. Management of Pediatric Urticaria with Review of the Literature on Chronic Spontaneous Urticaria in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1152-1161. [PMID: 29550102 DOI: 10.1016/j.jaip.2018.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/16/2018] [Indexed: 12/26/2022]
Abstract
There are substantial knowledge gaps related to diagnosis and management of pediatric cases of chronic urticaria, and in particular chronic spontaneous urticaria (CSU). In this article we aimed to review the diagnosis and management of chronic urticaria in children and CSU in particular. We conducted a systematic review of articles published in English and French on pediatric CSU management in the last 10 years. We included experimental studies (eg, randomized controlled trials), other experimental designs (eg, nonrandomized methods of assignment, controlled before-after studies, and interrupted time series), and observational studies (eg, prospective or retrospective cohort studies, cross-sectional studies, case-control studies, and case reports). Our findings highlight the efficacy of second-generation antihistamines for the treatment of CSU in children and supports the use of omalizumab for more severe cases. However, our study also reveals severe knowledge gaps related to the best management strategy in children with more severe/refractory cases of CSU. Future studies are required to establish the beneficial effect of high doses of second-generation antihistamines as well as the effectiveness and safety of omalizumab and other biologics in young children.
Collapse
Affiliation(s)
- Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Clive E Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, United Kingdom
| |
Collapse
|
33
|
Goldstein S, Gabriel S, Kianifard F, Ortiz B, Skoner DP. Clinical features of adolescents with chronic idiopathic or spontaneous urticaria: Review of omalizumab clinical trials. Ann Allergy Asthma Immunol 2017; 118:500-504. [PMID: 28390587 DOI: 10.1016/j.anai.2017.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adults and adolescents were included in 3 phase 3 omalizumab trials in chronic idiopathic urticaria (CIU): ASTERIA I, ASTERIA II, and GLACIAL. OBJECTIVE To describe the baseline clinical profile of adolescent patients with CIU enrolled in the omalizumab trials to add to the limited literature available on CIU in this population. METHODS Data for patient demographics, baseline clinical disease characteristics, medical history, and previous CIU medication information (not efficacy assessments) from phase 3 omalizumab trials were pooled and descriptive statistical analyses performed for adolescent (12 to <18 years old) and adult (≥18 years old) subgroups. Inferential analysis was inappropriate, partly because of small sample size in the adolescent subgroup. RESULTS The pooled population of 975 patients with CIU included 39 adolescents (4.0%). Demographics of adolescents and adults with CIU were similar, but compared with adults, fewer adolescents had positive Chronic Urticaria Index test results. Baseline clinical disease characteristics were also similar between the subgroups, with the number of previous CIU medications slightly lower in adolescents compared with adults. Medical history and existing conditions in adolescents tended to be more allergy than cardiovascular related, and fewer experienced angioedema compared with adults. CONCLUSION Pooled data indicate differences in baseline demographic and clinical characteristics between adult and adolescent patient subgroups. This finding helps augment our understanding of the clinical profile of CIU in adolescents, but larger-scale studies in this population are warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01287117 (ASTERIA I), NCT01292473 (ASTERIA II), and NCT01264939 (GLACIAL).
Collapse
Affiliation(s)
| | - Susan Gabriel
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Farid Kianifard
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - David P Skoner
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| |
Collapse
|
34
|
Mavrogiorgou P, Juckel G. [Dermatological diseases and their importance for psychiatry]. DER NERVENARZT 2017; 88:254-267. [PMID: 26975652 DOI: 10.1007/s00115-016-0082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.
Collapse
Affiliation(s)
- P Mavrogiorgou
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland
| | - G Juckel
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland.
| |
Collapse
|
35
|
Arik Yilmaz E, Karaatmaca B, Sackesen C, Sahiner UM, Cavkaytar O, Sekerel BE, Soyer O. Parasitic Infections in Children with Chronic Spontaneous Urticaria. Int Arch Allergy Immunol 2016; 171:130-135. [DOI: 10.1159/000450953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
|
36
|
Kolkhir P, Pogorelov D, Olisova O, Maurer M. Comorbidity and pathogenic links of chronic spontaneous urticaria and systemic lupus erythematosus--a systematic review. Clin Exp Allergy 2016; 46:275-87. [PMID: 26545308 DOI: 10.1111/cea.12673] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic spontaneous urticaria (CSU) is a common mast cell-driven disease characterized by the development of wheals (hives), angioedema (AE), or both for > 6 weeks. It is thought that autoimmunity is a common cause of CSU, which is often associated with autoimmune thyroiditis, whereas the link to other autoimmune disorders such as systemic lupus erythematosus (SLE) has not been carefully explored. Here, we systematically reviewed the existing literature for information on the prevalence of CSU in SLE (and vice versa) and we examined the possible clinical and pathogenetic relationship between CSU and SLE. The prevalence of CSU and CSU-like rash in SLE was investigated by 42 independent studies and comorbidity in adult patients reportedly ranged from 0% to 21.9% and 0.4% to 27.5%, respectively (urticarial vasculitis: 0-20%). In children with SLE, CSU was reported in 0-1.2% and CSU-like rash in 4.5-12% (urticarial vasculitis: 0-2.2%). In contrast, little information is available on the prevalence of SLE in patients with CSU, and more studies are needed to determine the rate of comorbidity. Recent insights on IgG- and IgE-mediated autoreactivity suggest similarities in the pathogenesis of CSU and SLE linking inflammation and autoimmunity with the activation of the complement and coagulation system. Future studies of patients with either or both conditions could help to better define common pathomechanisms in CSU and SLE and to develop novel targeted treatment options for patients with CSU and SLE.
Collapse
Affiliation(s)
- P Kolkhir
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - D Pogorelov
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - O Olisova
- Department of Dermatology and Venereology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
37
|
A prospective ten-year follow-up of patients with chronic urticaria. Allergol Immunopathol (Madr) 2016; 44:286-91. [PMID: 27083494 DOI: 10.1016/j.aller.2015.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/01/2015] [Accepted: 10/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic urticaria can be the initial clinical presentation of a number of different diseases. The objective of the present study was to report the associated diseases during a ten-year clinical-laboratory follow-up in patients with an initial diagnosis of chronic spontaneous urticaria (CSU) of unknown cause. METHODS A prospective, longitudinal cohort study with a ten-year clinical-laboratory follow-up was conducted. Patients with a history of urticarial plaques of over six weeks presenting as the only clinical symptom were selected. Individuals with other clinical conditions, urticaria of known causes or chronic physical urticaria were excluded. The following tests were initially performed: haemogram, urine type I, stool parasite exam and sedimentation rate. The following exams were ordered during follow-up: PPD; urine culture; serology tests; antithyroid and antinuclear antibodies, rheumatoid factor, lupus anticoagulant; thyroid hormones; serum immunoglobulin; paranasal sinus and thorax radiographs; testing for BK and Helicobacter pylori; and prick tests. RESULTS Infections were diagnosed in 29% of patients (syphilis, parasitosis, H. pylori, urinary infection, tuberculosis, hepatitis B and C); autoimmune diseases in 21% (thyroiditis, rheumatoid arthritis and antiphospholipid antibody syndrome); primary immunodeficiencies in 4% (IgA and IgG2 deficiencies); and chronic myeloid leukaemia in 1%. At ten-years of follow-up, the urticaria diagnosis was CSU of unknown cause in 45% of the cases. CONCLUSION This ten-year clinical-laboratory follow-up of 100 individuals with chronic urticaria as the initial diagnosis revealed the presence of associated diseases in over half of the cases. The most prevalent diseases were infections and autoimmune diseases besides primary immunodeficiencies and blood diseases.
Collapse
|
38
|
Kolkhir P, Balakirski G, Merk HF, Olisova O, Maurer M. Chronic spontaneous urticaria and internal parasites--a systematic review. Allergy 2016; 71:308-22. [PMID: 26648083 DOI: 10.1111/all.12818] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 01/09/2023]
Abstract
Chronic spontaneous urticaria (CSU) is defined as persistent wheals, angioedema, or both lasting for >6 weeks due to known or unknown causes. Some epidemiological studies and case reports suggest that internal parasite infections (PI) can cause CSU. Here, we provide a systematic overview of published findings on the prevalence and relevance of PI in CSU and we discuss possible pathomechanisms. The prevalence of PI in CSU was investigated by 39 independent studies and comorbidity reportedly ranged from 0 to 75.4% (two-thirds of these studies reported infection rates of 10% or less). The prevalence of PI in adult and pediatric CSU patients ranged from 0% to 75.4% and from 0% to 37.8%, respectively. CSU patients were more often diagnosed with protozoa and had a significantly higher risk of toxocariasis seropositivity and Anisakis simplex sensitization when compared to healthy controls. Patients with chronic urticaria more frequently had seropositivity of fasciolosis, Anisakis simplex sensitization, and the presence of Blastocystis hominis allele 34 (ST3) as compared with control subjects. In 21 studies, efficacy of treatment with antiparasitic drugs ranged from 0 to 100% (35.7% of 269 CSU patients benefitted). In 9 (42.8%) of 21 studies, more than 50% of efficacy was observed. The reported rate of urticaria comorbidity in PI patients in 18 independent studies is 1-66.7%. Urticaria including CSU might be a quite common symptom of strongyloidiasis and blastocystosis. Pathogenic mechanisms in CSU due to PI may include specific IgE, Th2 cytokine skewing, eosinophils, activation of the complement, and the coagulation systems.
Collapse
Affiliation(s)
- P. Kolkhir
- Department of Dermatology and Venereology; Sechenov First Moscow State Medical University; Moscow Russia
| | - G. Balakirski
- Department of Dermatology and Allergology; University Hospital of Aachen; Aachen Germany
| | - H. F. Merk
- Department of Dermatology and Allergology; University Hospital of Aachen; Aachen Germany
| | - O. Olisova
- Department of Dermatology and Venereology; Sechenov First Moscow State Medical University; Moscow Russia
| | - M. Maurer
- Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
39
|
|
40
|
Choi SH, Baek HS. Approaches to the diagnosis and management of chronic urticaria in children. KOREAN JOURNAL OF PEDIATRICS 2015; 58:159-64. [PMID: 26124845 PMCID: PMC4481035 DOI: 10.3345/kjp.2015.58.5.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/17/2015] [Indexed: 01/02/2023]
Abstract
Most guidelines for chronic urticaria (CU) in infants and children are based on limited pediatric evidence. Current evidence used to guide treatment in children is extrapolated from data focusing on older age groups. CU in children is a different and complex condition than that in adults. Furthermore, there is little published information regarding urticaria in Korean children. The aim of the present article is to review recent research on chronic childhood urticaria and improve the current understanding of its pathogenesis and management. The classification and definition of urticaria in adults also applies to children. CU is defined as a daily occurrence of spontaneous wheals, angioedema, or both for >6 weeks. The precise pathophysiology of CU is unknown and the rates of successful identification of a cause in children with CU vary from 20%-50%. There is no established laboratory test to evaluate the presence of urticaria. The natural course of childhood CU is undetermined, with limited reports discussing long-term outcomes. Second-generation H1 antihistamines are the cornerstone of management, while limited therapeutic drugs are available for adults.
Collapse
Affiliation(s)
- Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hey Sung Baek
- Department of Pediatrics, Gangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| |
Collapse
|
41
|
Ye YM, Jang GC, Choi SH, Lee J, Yoo HS, Park KH, Shin M, Kim J, Lee SY, Choi JH, Ahn Y, Park HS, Chang YS, Jeong JW, Lee S. KAAACI Work Group report on the management of chronic urticaria. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.1.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Maeil Central Research Laboratory, Pyeongtaek, Korea
| | - Hye-Soo Yoo
- Suwon Center for Environmental Disease and Atopy, Suwon, Korea
| | - Kyung Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jihyun Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Youngmin Ahn
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Jeong
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | | |
Collapse
|
42
|
Hsieh PY, Chang CY, Chou CC, Lin YR, Chen CY. Urticaria in adolescence increases the risk of developing new-onset depression: A database study. J Acute Med 2014. [DOI: 10.1016/j.jacme.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
43
|
Kuo CL, Chen CY, Huang HL, Chen WL, Lee HC, Chang CY, Chou CC, Ho SY, Wu HP, Lin YR. Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study. BMC Pediatr 2014; 14:181. [PMID: 25012668 PMCID: PMC4105518 DOI: 10.1186/1471-2431-14-181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/09/2014] [Indexed: 12/13/2022] Open
Abstract
Background Non-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash appearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive stress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major depression after a first-attack and non-infection caused urticaria. Methods This study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized for a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with 17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or depression prior to the evaluation period were excluded. Each patient was followed for one year to identify the occurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression, adjusting for the subjects’ sociodemographic characteristics. Depression-free survival curves were also analyzed. Results Thirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects suffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis showed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI, 1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI 2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78). Conclusion Individuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing major depression.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Shinn-Ying Ho
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
| | | | | |
Collapse
|
44
|
Update on Antihistamine Treatment for Chronic Urticaria in Children. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-014-0023-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Affiliation(s)
- Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
46
|
Hakimeh D, Tripodi S. Recent advances on diagnosis and management of childhood asthma and food allergies. Ital J Pediatr 2013; 39:80. [PMID: 24373684 PMCID: PMC3891976 DOI: 10.1186/1824-7288-39-80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/16/2013] [Indexed: 11/10/2022] Open
Abstract
The epidemic of childhood allergic disorders has been associated to the decline of infectious disease. However, exposure to many triggers (airborne viruses, tobacco smoke, pollution, indoor allergens, etc.) contribute to the disease. Breast feeding practices, nutrition, dietary and obesity also play a multifaceted role in shaping the observed worldwide trends of childhood allergies. Guidelines for treatment are available, but their implementation is suboptimal. Then developed countries are slowing learning integrating the development of suitable guidelines with implementation plans. Awareness, psychosocial and family factors strongly influence asthma and food allergy control. Moreover, monitoring tools are necessary to facilitate self-management. By taking into consideration these and many other pragmatic aspects, national public health programs to control the allergic epidemic have been successful in reducing its impact and trace the need for future research in the area.
Collapse
Affiliation(s)
| | - Salvatore Tripodi
- Department of Paediatrics and Allergology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini, 389, 00157 Rome, Italy.
| |
Collapse
|