PDF(Pubmed)
Abstract：
Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.
摘要：
背景和目的：儿童慢性荨麻疹指南包含通常基于成人研究的建议。诊断途径尚未标准化，抗H1，奥马珠单抗的有效性，孟鲁司特,在儿科人群中很少报道全身性糖皮质激素。研究之间的慢性荨麻疹缓解率差异很大。这项研究的目的是提高我们对小儿慢性荨麻疹的认识。材料与方法：本研究纳入37例慢性荨麻疹患儿，年龄0～18岁。人口统计参数，病史,临床特征,收集实验室数据和治疗信息.儿童接受推荐剂量的第二代H1抗组胺药治疗，增加了两倍。奥马珠单抗用于难治性抗H1患者。对严重加重的患者进行为期三天的全身性糖皮质激素治疗。孟鲁司特对一些儿童进行了治疗。结果：常见无血管性水肿的病例。32例(86.48%)儿童出现自发性慢性荨麻疹,可诱导2（5.41%），由1中的寄生虫和2中的血管诱导。治疗慢性荨麻疹的潜在原因没有益处，除了消灭脆弱的Dientamoeba。45.9％的病例在三年内解决了慢性荨麻疹。9名儿童（24.32％）存在过敏性疾病，3名（8.11％）存在自身免疫性疾病。所有儿童均接受许可剂量或更高剂量的抗H1治疗。在29名(78.38%)患者中观察到抗H1的部分或完全反应。孟鲁司特没有任何好处。所有接受奥马珠单抗治疗的儿童均有反应。全身性糖皮质激素已成功用于治疗急性发作。结论：我们的发现表明，在没有临床怀疑的情况下，不应常规进行实验室检查。然而,合并症，如甲状腺自身免疫性疾病和乳糜泻，建议在慢性荨麻疹过程中进行监测。可以从慢性荨麻疹的诊断框架中诊断这些临床状况。增加抗H1和奥马珠单抗的剂量对标准治疗耐药的儿童有效，但我们仍需要进一步研究以产生以患者为中心的标准治疗。
