Purpose of the Study
This study sought to define the clinical, etiologic, and prognostic features of acute urticaria in infancy and early childhood.
Fifty-seven infants and children between the ages of 1 and 36 months with acute urticaria.
This was a prospective study of 57 consecutive infants who were admitted to a pediatric hospital with acute urticaria over a 2-year period. All children underwent an extensive evaluation including blood counts, bacterial cultures, cultures and titers for viral pathogens, and allergy tests for penicillin and foods where indicated. Follow-up was attempted 2 months and 1 to 2 years after the initial presentation.
Hemorrhagic lesions were observed in 28 patients (49% of cases) and angioedema was present in 34 (60%). An underlying cause was suspected or identified in 52 patients (91%). Infection, either alone or associated with drug intake, was determined to be the cause in 46 patients (81%) and foods were the cause in 6 (11%). Twenty-nine children were taking antibiotics, although none of the 9 children who had penicillin allergy testing performed were positive. Hemorrhagic lesions and associated articular symptoms were more common in urticaria caused by infection. There was a history of atopy in the family or the patient in 33 cases (58%) and a history of atopic dermatitis was particularly associated with urticaria caused by food. One- to 2-year follow-up was available in 40 of the 57 children, revealing that 12 (30%) had chronic (3 cases) or recurrent (9 cases) urticaria.
Viral illnesses, often associated with antibiotic therapy, were by far the most common cause of acute urticaria in infants and young children.
This is an excellent study of a common and frustrating condition. I am particularly fond of this study because it confirms my long held bias that viral infection is the most common cause of acute urticaria in children. The main drawback of the study is that it only included hospitalized children and may therefore not be completely representative of all childhood urticaria.