From the Guidelines
The management of urticaria in pediatric patients involves a stepwise approach starting with second-generation H1 antihistamines as first-line therapy, with cetirizine, loratadine, or fexofenadine being preferred due to their minimal sedating effects and once-daily dosing. For inadequate symptom control, the antihistamine dose can be increased up to four times the standard dose 1. Acute urticaria episodes may require a short course of oral corticosteroids such as prednisolone (1 mg/kg/day for 3-5 days) for severe symptoms. Identifying and avoiding triggers is essential, including certain foods, medications, physical stimuli, or infections. For chronic urticaria unresponsive to antihistamines, referral to a pediatric allergist or dermatologist is recommended for consideration of second-line therapies such as omalizumab, cyclosporine, or leukotriene receptor antagonists like montelukast 1. Patient education about the typically self-limiting nature of acute urticaria and the importance of medication adherence for chronic cases is crucial. Cool compresses, loose clothing, and lukewarm baths with colloidal oatmeal can provide symptomatic relief. Antihistamines work by blocking histamine receptors, reducing the inflammatory response that causes the characteristic wheals and itching in urticaria.
Some key points to consider in the management of urticaria in pediatric patients include:
- The use of antihistamines above the manufacturers’ recommended dose may be necessary for some patients 1
- Referral to a pediatric allergist or dermatologist is recommended for patients with chronic urticaria unresponsive to antihistamines 1
- Allergen immunotherapy can be considered for children with allergic rhinitis, asthma, or stinging insect hypersensitivity, and can be initiated in young children if indicated 1
- Patient education and avoidance of triggers are essential components of urticaria management 1
Overall, the management of urticaria in pediatric patients requires a comprehensive approach that takes into account the individual patient's needs and circumstances, and may involve a combination of pharmacologic and non-pharmacologic therapies.
From the Research
Urticarial Causes in Pediatrics
- Urticaria is a common skin condition characterized by itchy, raised welts [(2,3,4)].
- The management of urticaria in pediatric patients typically involves the use of antihistamines, such as cetirizine, fexofenadine, and loratadine [(2,4)].
Treatment of Urticaria
- A step-by-step approach to the management of chronic urticaria is proposed, starting with non-sedating H(1) receptor antagonists (antihistamines) 2.
- Corticosteroid therapy with prednisone or methylprednisolone can be administered for a few days if urticarial symptoms are not controlled by antihistamines 2.
- Leukotriene receptor antagonists, such as montelukast and zafirlukast, can be tried in cases of relapse after corticosteroid suspension 2.
Acute Urticaria
- The treatment of acute urticaria is less well-studied, with few clinical trials addressing its management 3.
- The addition of corticosteroids to antihistamines may not improve symptoms of acute urticaria 3.
- The combination of diphenhydramine and ranitidine or cimetidine may be effective for relief of urticaria in some cases 3.