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Few data are comparing chronic spontaneous urticaria (CSU) in children and adults. Balp et al 1 conducted an important online survey in five different European countries, with physicians that had seen at least one pediatric patient with CSU in the last 12 months. Their results suggest that the prevalence of chronic urticaria and CSU in children is similar to that observed in adults.On the other hand, they showed that there is a lower prevalence of angioedema in pediatric populations when compared to adults.They also highlight treatment patterns among this population indicating that a significant proportion of these patients are treated with H1-antihistamines, but around 1/3 of them are refractory to higher doses.We conducted a retrospective analysis of medical records of patients treated at a center of excellence and reference in urticaria (UCARE) from April 2016 to June 2017. Disease characteristics and treatment patterns and response in children were compared to adults. The study was approved by the Ethics Committee, who waived the consent from patients, as it was a retrospective chart review.A total of 113 patients with CSU between 4 and 76 years of age were evaluated, 31 of whom were children (aged 0-17 years). There was a higher prevalence in females in both groups, in a ratio of 5.8:1 in adults and 1.6:1 in children. In contrast to Balp et al, 1 most of our pediatric patients had angioedema (58%), and its presence was not related to disease duration or severity based on clinical criteria and urticaria activity score in 7 days (UAS7). Similar results were observed in adults. On the other hand, the length of the disease was on average longer in adults (310 weeks) than in children (170 weeks), but the more prolonged disease was associated with severity in neither group.The presence of comorbidities such as atopy and autoimmunity was assessed, based on clinical history and the presence of laboratory markers (ANA and thyroid autoantibodies), respectively. Atopy was more prevalent in children (58%) than in adults (23%; P < 0.05), but there was no significant difference in autoimmunity prevalence between adults and children (21.9% and 29%, respectively).Nonsteroidal antiinflammatory drugs (NSAIDs) is the leading cause of drug hypersensitivity reactions in our region, 2 and angioedema is the most frequent clinical manifestation. NSAIDs were associated with CSU exacerbations in up to 20% of patients, but more frequently in adults (25.6%) than in children (6.5%; P < 0.05).However, patients with angioedema were not at a higher risk of NSAID exacerbations. Urticaria treatment aims total symptom control (UAS7 ≤ 6). 3 In our study, children achieved better disease control (64.5%) when compared to adults (37.8%; P < 0.05). H1-antihistamines are recommended as first-and second-line treatment for CSU. 3 The majority of our pediatric patients (84%) are under treatment with an H1-antihistamine, but only 35% in licensed doses. Disease control was observed in 19% of children and 16% of the adults treated with these doses. Hi...

Área do Trabalho: Pediatria Data da submissão:09/08/2018 às 14:29 Justificativa Síndrome de Stevens-Johnson (SSJ) e Necrólise Epidérmica Tóxica (NET), são reações cutâneas de hipersensibilidade tardia, associadas a drogas e infecções, graves e cuja mortalidade pode chegar a 19,4%. A etiopatogenia e tratamento são pouco conhecidos e controversos.

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