A Practical Up-to-Date Approach to Managing Acute Urticaria in Children

To provide an up-to-date on paediatric acute urticaria (AU) management, highlighting recent publications.

In more than 30% of children with AU, no specific cause is identified. Infections are consistently the most reported potential triggers, followed by food and drug hypersensitivity. Specific triggers aren’t associated with AU severity. Older age and the presence of concomitant angioedema are associated with urticaria persistence. There are worldwide differences regarding available second-generation H1-antihistamines (2ndGAH) and also licensed doses. Evidence on up-dosing 2ndGAH in paediatric urticaria is scarce, but the use of cetirizine may result in increased dose-dependent sedation. Other topical and systemic treatments are being used; not all are evidence-based. Educational training sessions on urticaria management are effective in enhancing physicians’ compliance with current recommendations.

A comprehensive clinical history is the key factor for the identification of treatable AU causes. Oral 2ndGAH should be widely available as the first-line treatment. At least doubling the standard dose of low sedative potential 2ndGAH can be useful, if symptoms persist or in moderate-severe urticaria. Short-term oral corticosteroids may be added in severe AU, including children with significant or predominant angioedema. Clinical trials on larger paediatric populations are needed to support evidence-based recommendations.