Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
Pediatr Allergy Immunol. 2021 Jan;32(1):153-160. doi: 10.1111/pai.13325. Epub 2020 Aug 26.
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 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 s in children with CSU in a tertiary care pediatric hospital.
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.
Sixty-six cases of CSU were identified, and all of them were treated initially with a standard dose of sgAH s, followed by increased doses up to fourfold when standard dosing was not effective. 44/66 patients (66.7%) treated with sgAH 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 s because of the relapse of the symptoms after the stepped-down dosage. Regarding tolerability, 9/66 (13.6%) patients treated with sgAH s experienced side effects: three that required treatment change and six that did not.
Our data were consistent with the tolerability of updosing of sgAH s in children with CSU, although the efficacy appears to be limited to double the standard dose.
慢性荨麻疹（CU）是一种常见的皮肤疾病，其特征为每天出现风团或血管性水肿，持续时间超过 6 周；CU 分为自发性（无特定诱发因素）或诱导性（存在特定诱发因素）。最近的 EAACI 慢性自发性荨麻疹管理指南建议，在儿童（按体重调整）和成人中，第二代非镇静 H1 抗组胺药（sgAHs）作为初始治疗，如标准剂量无效，则增加剂量（最高 4 倍）。成人中 4 倍剂量递增的疗效和耐受性已知，但关于儿科人群中剂量递增的文献较少。本回顾性研究评估了在一家三级儿童医院就诊的 CU 患儿中 sgAHs 剂量递增的疗效和耐受性。
对在 4 年内被诊断为 CU 并转诊至迈耶儿童医院过敏科的患者的电子病历进行了回顾。对每位患者进行了人口统计学特征、诊断性检查、治疗的疗效和耐受性的评估。使用 UAS7 监测疾病活动度。
共发现 66 例 CU 病例，所有患者均首先接受 sgAHs 标准剂量治疗，如标准剂量无效，则增加至 4 倍剂量。在接受 sgAHs 治疗的 66 例患者中，有 44 例（66.7%）有效：25 例接受标准剂量，16 例接受双倍剂量，2 例接受 3 倍剂量，1 例接受 4 倍剂量。12/66（18.2%）例患者开始接受奥马珠单抗治疗。对于其余的患者，10/66（15.1%）例患者由于症状减轻后剂量降低而复发，仍在接受 sgAHs 治疗。在耐受性方面，9/66（13.6%）接受 sgAHs 治疗的患者出现了不良反应：3 例需要改变治疗方案，6 例不需要。
我们的数据与儿童 CU 患者中 sgAHs 剂量递增的耐受性一致，尽管疗效似乎仅限于标准剂量的 2 倍。
