PURPOSE OF THE STUDY.
Chronic spontaneous urticaria (CSU) in childhood is infrequent, and information about the disease is limited. The study investigated its etiologic factors, natural course, and predictors of prognosis.
All children aged 18 years or younger in a cohort from Turkey who were diagnosed with CSU during during an 8-year period.
Retrospective analysis of the medical records of these patients was performed, and the final outcomes were queried via a telephone interview.
One hundred patients (male/female ratio, 1.27) with a median age of 9.2 years (range, 0.7–17.2) at symptom onset were evaluated. The median follow-up was 2.5 years (range, 0.2–18.1). An autologous serum skin test was positive in 46.7% of the subjects (n = 45), with a female predominance (71.4%; P = .023). In 13.8% of the children, antinuclear antibody titers were >1:100. Food allergy (n = 1), thyroid autoantibodies (n = 3), possible collagen disease (n = 1), and drug use (deferoxamine) (n = 1) were found to be associated factors. Infections could not be confirmed as the cause of CSU. Recovery was seen in 16.5%, 38.8%, and 50.0% of the children after 12, 36, and 60 months, respectively. Though in multivariate analysis none of the factors, including age, gender, autologous serum skin test positivity, the presence of angioedema, or other allergic diseases appeared to predict the prognosis, in univariate analysis, being female and being older than 10 years predicted an unfavorable prognosis.
The etiology of CSU in children is mainly related to an autoreactive background, as in adults. CSU has a favorable prognosis, and resolution is seen in half of the children within 5 years. Girls older than 10 years may have an unfavorable prognosis.
CSU is characterized by recurrent urticaria persisting for longer than 6 weeks. The disorder has a significant impact on the quality of life. While the diagnosis of CSU is based on clinical findings, identification of the etiologic factors responsible for this disease is often challenging. There are limited studies examining the etiology and natural history of CSU in children. The results of this study suggest that autoimmunity plays a role in a significant subset of children with CSU. Furthermore, this study provides long-term follow-up data on children with CSU, indicating a favorable prognosis.
- Copyright © 2012 by the American Academy of Pediatrics