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Lee XH, Ong LX, Cheong JY, et al. A stepwise approach in the management of chronic spontaneous urticaria in children. Asia Pac Allergy. 2016;6(1):16-28doi: 10.5415/apallergy.2016.6.1.16.
Lee, X. H., Ong, L. X., Cheong, J. Y., Sultana, R., Rao, R., Lim, H. H., Ding, X. M., Loh, W. Y., Punan, M., & Chiang, W. C. (2016). A stepwise approach in the management of chronic spontaneous urticaria in children. Asia Pacific allergy, 6(1), 16-28. https://doi.org/10.5415/apallergy.2016.6.1.16
Lee, Xin Hui Magdeline, et al. "A stepwise approach in the management of chronic spontaneous urticaria in children." Asia Pacific allergy vol. 6,1 (2016): 16-28. doi: https://doi.org/10.5415/apallergy.2016.6.1.16
Lee XH, Ong LX, Cheong JY, Sultana R, Rao R, Lim HH, Ding XM, Loh WY, Punan M, Chiang WC. A stepwise approach in the management of chronic spontaneous urticaria in children. Asia Pac Allergy. 2016 Jan;6(1):16-28. doi: 10.5415/apallergy.2016.6.1.16. Epub 2016 Jan 27. PMID: 26844216; PMCID: PMC4731476.
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Asia Pac Allergy. 2016 Jan;6(1):16-28. doi: 10.5415/apallergy.2016.6.1.16. Epub 2016 Jan 27.

A stepwise approach in the management of chronic spontaneous urticaria in children.

Asia Pacific allergy

Xin Hui Magdeline Lee, Lin Xin Ong, Jing Yi Vanessa Cheong, Rehena Sultana, Rajeshwar Rao, Hwee Hoon Lim, Xiao Mei Ding, Wen Yin Loh, Monika Punan, Wen Chin Chiang

Affiliations

  1. Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
  2. Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
  3. Duke-NUS Graduate Medical School Singapore, Singapore 169857, Singapore.

PMID: 26844216 PMCID: PMC4731476 DOI: 10.5415/apallergy.2016.6.1.16

Abstract

BACKGROUND: There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies.

OBJECTIVE: Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children.

METHODS: A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study.

RESULTS: Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control.

CONCLUSION: We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.

Keywords: Algorithms; Child; Chronic Urticaria; Histamine Antagonists

References

  1. Ann Allergy. 1992 Jul;69(1):61-5 - PubMed
  2. Pediatr Allergy Immunol. 2010 Aug;21(5):837-42 - PubMed
  3. J Allergy Clin Immunol. 2003 May;111(5):1095-8 - PubMed
  4. Int Arch Allergy Immunol. 2007;144(1):51-6 - PubMed
  5. World Allergy Organ J. 2008 Jun;1(6):103-13 - PubMed
  6. Curr Opin Allergy Clin Immunol. 2005 Oct;5(5):403-7 - PubMed
  7. J Allergy Clin Immunol. 2004 Sep;114(3):465-74; quiz 475 - PubMed
  8. Allergy. 2013 Feb;68(2):229-35 - PubMed
  9. Allergy Asthma Clin Immunol. 2011 Nov 10;7 Suppl 1:S9 - PubMed
  10. Pediatr Allergy Immunol. 2008 Jun;19(4):363-6 - PubMed
  11. Clin Exp Allergy. 2007 May;37(5):631-50 - PubMed
  12. Arch Dis Child. 2003 Jun;88(6):517-9 - PubMed
  13. PLoS One. 2013 Jul 23;8(7):e69345 - PubMed
  14. Allergy. 2009 Oct;64(10):1427-43 - PubMed
  15. Allergy Asthma Clin Immunol. 2015 Feb 11;11(1):7 - PubMed
  16. Allergy. 2008 Jun;63(6):777-80 - PubMed
  17. Pediatr Allergy Immunol. 2010 May;21(3):508-14 - PubMed
  18. Asian Pac J Allergy Immunol. 1986 Jun;4(1):41-5 - PubMed
  19. Clin Exp Dermatol. 2007 Jan;32(1):34-8 - PubMed
  20. Pediatrics. 2005 Nov;116(5):e675-80 - PubMed
  21. Singapore Med J. 2014 May;55(5):244-7 - PubMed
  22. Clin Ther. 1997 Jan-Feb;19(1):39-55; discussion 2-3 - PubMed
  23. Br J Dermatol. 2002 Jan;146(1):101-6 - PubMed
  24. Cochrane Database Syst Rev. 2014 Nov 14;(11):CD006137 - PubMed
  25. Int Arch Allergy Immunol. 2011;156(2):224-30 - PubMed

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