The common triggers of urticaria in children admitted to the pediatric emergency room

Abstract

Background Urticaria frequently causes pediatric emergency department (PED) admissions. Children with urticaria may unnecessarily avoid suspected allergens. We aimed to investigate the possible and exact triggers of urticaria in children admitted to the PED. Methods Medical records of children admitted to the PED within a 1‐year period were evaluated for the International Classification of Diseases 10 (ICD‐10) L50 urticaria code, noting symptoms, and possible triggers of urticaria. We performed telephone interviews to complete the missing data and further diagnostic tests for IgE‐mediated allergies to identify the exact triggers of urticaria. Results Among 60,142 children, 462 (0.8%) with the L50 code were evaluated. Possible triggers based on the history and physical examination could be identified in 46%: infections (18%), drugs (11%), foods (8%), infections and drugs (3%), insects (3%), pollen (1%), blood products (0.4%), and vaccines (0.4%). The most frequent infections related to urticaria were upper respiratory tract infections (74.5%), urinary tract infections (13.2%), gastroenteritis (8.2%), and otitis media (4.1%). After a diagnostic workup, IgE‐mediated allergic diseases were diagnosed in 6% of patients. Twenty‐two percent of the patients had multiple PED admission for the same urticaria flare. Urticaria severity was found to be the most important risk factor for readmissions to the PED (odds ratio: 3.86; 95% confidence interval: 2.39–6.23; p < .001). No relationship between urticaria severity, duration, and the triggers was present. Conclusions Despite detailed diagnostic tests, IgE‐mediated allergic triggers were rarely the cause of urticaria in children admitted to the PED. Infections are the most frequent trigger. Severe urticaria causes more frequent readmissions to the PED.

Urticaria in infants: A single‐institution retrospective study

“…Our study found that the majority of infants who present with urticaria of unknown etiology have AU and experience resolution even if the cause remains unidentified. Our results are consistent with prior studies in older children which showed that underlying etiology is unidentified in approximately half of pediatric AU and CU cases, even if further laboratory workup (e.g., complete blood count, IgE test, autologous serum skin test, and thyroid studies) is pursued 7,8 . In our cohort, food allergy and infection were two most common AU etiologies eventually identified, which is consistent with prior literature 2,8 .…”

“…Our results are consistent with prior studies in older children which showed that underlying etiology is unidentified in approximately half of pediatric AU and CU cases, even if further laboratory workup (e.g., complete blood count, IgE test, autologous serum skin test, and thyroid studies) is pursued. 7,8 In our cohort, food allergy and infection were two most common AU etiologies eventually identified, which is consistent with prior literature. 2,8 Our data support the latest clinical guidelines for adult and pediatric urticaria, which recommend allergy tests for AU only in the context of appropriate clinical history.…”

“…7,8 In our cohort, food allergy and infection were two most common AU etiologies eventually identified, which is consistent with prior literature. 2,8 Our data support the latest clinical guidelines for adult and pediatric urticaria, which recommend allergy tests for AU only in the context of appropriate clinical history. 3,4 Based on our findings, further testing or workup is likely not necessary due to the likelihood of self-resolution.…”

Urticaria acute and chronic

“…3 Drugi vodeći uzročnik AU jesu IgEpo sredovane reakcije na nutritivne alergene (proteini kravljeg mlijeka, jaja, kikiriki, orašasti plodovi, riba), aditive u hrani (Na benzoati, salicilati, umjetne arome, boje), lijekove (betalaktamski i drugi antibiotici, anal getici, opioidi, kontrastna sredstva za snimanje). 3,4 AU je u većini slučajeva samoizlječiva bolest benignog tije ka. Kod dokazanog alergijskog uzročnika AU u terapi ju se uvode antihistaminici druge generacije, 5 no ako se dokaže bakterijska infekcija betahemolitičkim streptokokom grupe A ili Mycoplasmom pneumoniae, potrebno je provesti antimikrobno liječenje.…”

“…2,3 Smatra se kako 1% djece godišnje razvije simptome urtikarije. 4 Diferen cijalno dijagnostički, urtikariju se mora razlikovati od drugih stanja poput anafilaksije, mastocitoze, autoin flamatornih sindroma, urtikarijalnog vaskulitisa, sin droma aktivacije makrofaga ili bradikininom posredo vanog angioedema, koja se također mogu prezentirati istom ili sličnom kliničkom slikom, no zbog jasno raz ličitoga patofiziološkog mehanizma nastanka ne ubra jaju se u podtipove urtikarija. 1,3 Prema vremenu na stanka urtikariju dijelimo na akutnu i kroničnu, a kro ničnu urtikariju dijelimo dalje u podtipove ovisno o uzročniku.…”