Efficacy and tolerability of the updosing of second‐generation non‐sedating H1 antihistamines in children with chronic spontaneous urticaria

Abstract

Background: Chronic urticaria (CU), daily wheals or angioedema that lasts more than 6 weeks, is a common skin disease; CU is classified as spontaneous (no specific eliciting factor involved) or inducible (specific eliciting factor involved). Recent EAACI guidelines for management of CSU recommend second-generation non-sedating H1 antihistamines (sgAH 1 s) as initial treatment in children (weight-adjusted) as in adults, followed by increased doses (up to 4 times) if the standard dose is not effective. The efficacy and tolerability of fourfold updosing in adults are known, but there is little documentation regarding updosing in the pediatric population. This retrospective study evaluates the efficacy and tolerability of the updosing of sgAH 1 s in children with CSU in a tertiary care pediatric hospital. Methods: The electronic charts of patients diagnosed with CSU and referred to the Allergy Unit of Meyer Children's University hospital were reviewed during a period of 4 years. For each patient, an examination of demographic characteristics, diagnostic workup, efficacy, and tolerability of the treatment was performed. Disease activity was monitored using UAS7. Results: Sixty-six cases of CSU were identified, and all of them were treated initially with a standard dose of sgAH 1 s, followed by increased doses up to fourfold when standard dosing was not effective. 44/66 patients (66.7%) treated with sgAH 1 s responded: 25 with a standard dose, 16 with a double, 2 with threefold dose, and 1 with fourfold dose. 12/66 (18.2%) patients began a therapy with omalizumab. As for the remaining patients, 10/66 (15.1%), they are still undergoing therapy with sgAH 1 s because of the relapse of the symptoms after the stepped-down dosage. Regarding tolerability, 9/66 (13.6%) patients treated with sgAH 1 s experienced side effects: three that required treatment change and six that did not. Conclusion: Our data were consistent with the tolerability of updosing of sgAH 1 s in children with CSU, although the efficacy appears to be limited to double the standard dose. How to cite this article: Sarti L, Barni S, Giovannini M, Liccioli G, Novembre E, Mori F. Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria.

Relapse or worsening of chronic spontaneous urticaria during SARS-CoV-2 infection and vaccination in children: A telemedicine follow-up

“…The detailed demographic data and the blood and stool test results are presented in Tables 2 and 3. As we discussed previously, 18 the main comorbidities associated with CSU in our patients were thyroid dysfunction (5/71, 7.1%), celiac disease (5/71, 7.1%), and rhinitis (16/71, 22.5%).…”

“…In the beginning, all 71 patients were evaluated for the first time in a face-to-face visit. Here, they were screened according to the diagnostic workup of our hospital, 18 and therapy was initiated or modulated according to the abovementioned guidelines. completely within 8 weeks.…”

“…The diagnostic workup schedule was same as the one described in the study by Sarti L. et al 18 In our practice, the CSU activity was monitored by using the UAS7 that the patients showed during all follow-up visits, and based on the weekly score, the therapy was adjusted.…”

Expert consensus on the use of omalizumab in chronic urticaria in China

“… 59 In a recent study, only 25 of 66 (38%) children with CU treated with a standard-dosed sgAH responded. 60 Omalizumab is licensed for children with asthma 6 years or older at higher doses than in CSU, which also suggests that omalizumab is generally safe for the use for children. Based on the available evidence, although small, and our clinical experience, we suggest that omalizumab may be an effective and safe choice for children with antihistamine-refractory CU.…”

Case Report: Refractory Chronic Spontaneous Urticaria Treated With Omalizumab in an Adolescent With Crohn’s Disease

“…If it was 1–15, the sgAH1 dose was maintained. Finally, if it was 0 for at least 2 weeks, a step-down in therapy was performed ( 10 ). After 4 weeks, the patient was evaluated again through telemedicine; due to the low disease control, we suggested increasing the sgAH1 dose to three times a day ( Figure 2 ).…”