NEW YORK (Reuters Health) – Combining oral and injectable antihistamines or corticosteroids appears more effective for treating acute urticaria in children than using just one treatment modality, Taiwanese researchers report in Pediatric Allergy and Immunology, online June 1.

Their retrospective study of 1120 children also shows that urticaria caused by infections and medications were related to a more severe clinical course of the disorder.

“We suggest that moderate to severe acute urticaria be managed with short-term observation and treated aggressively in the (pediatric observation unit) to avoid recurrent hospital shopping and to decrease the duration of urticaria,” Dr. Tzu-Hsuan Liu and colleagues write.

The investigators set out identify risk factors for urticaria, which they note have not been well studied in children. The average age of the children was 5.4 years, and all had presented with an initial episode of acute urticaria between 2001 and 2007 at the Changhua Christian Hospital in Taiwan.

Urticaria was rated from mild to severe by the number of wheals and the degree of pruritus. About a third of the children had allergic histories.

Infection was the most commonly diagnosed cause of the disorder (47.9%), followed by foods (23.7%), unknown causes (13%), medications (12.4%), inhalants (1.7%), insect bites (1.2%), and contact materials (0.2%).

On average, urticaria lasted 6.6 days, with symptoms resolving within 15 days in nearly 95% of children. The duration was shorter in those receiving oral plus IV antihistamines (5.2 days) compared to those who didn’t receive antihistamines (7.7 days, p<0.001) and those who received either oral (7.5 days) or IV treatment (7.0 days). Combined oral plus IV corticosteroids were also associated with significantly shorter duration of urticaria than oral treatment alone (p<0.001). The cause of urticaria, as diagnosed by the physician, had a significant influence on duration as well. Inhalants, for instance, were related to longest episodes, while contact materials were associated with the shortest (8.6 days vs. 3.5 days). Fever, gastrointestinal symptoms and angioedema all predicted more severe urticaria (p<0.001). Dr. Liu and colleagues recommend short-term observation and treatment for urticaria in the pediatric observation unit for children who present with an initial episode of acute urticaria concomitant with angioedema, since they are likely to have a moderately severe course. On the other hand, “hospital admission should be considered for children who presented with pyrexia and urticaria.” Reference:
http://www3.interscience.wiley.com/journal/123488366/abstract

Pediatr Allergy Immunol 2010.