Satapathy Amit, Biswal Basudev, Priyadarshini Lipsa, Sirka Chandrasekhar, Das Lipsa, Mishra Pritinanda, Patodia Sujata, Kar Subhashree, Mahapatro Samarendra, Das Rashmi R
Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND.
Dermatology, All India Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2020 Nov 15;12(11):e11489. doi: 10.7759/cureus.11489.
Background Urticaria is a type III hypersensitivity reaction usually triggered by an infection, medication, or food item. It usually subsides within 24 hours without any residual lesion and does not have any systemic manifestation. Urticaria vasculitis (UV) is a clinicopathological condition defined by the presence of an urticarial lesion lasting for >24 hours or recurrent episodes of urticaria associated with histopathological features of leukocytoclastic vasculitis. Methods This retrospective study was conducted in a tertiary care teaching institute in Eastern India over a period of 2 and ½ years. Children presenting with urticaria lesions for a duration of > 24 hours that did not subside either spontaneously or with anti-histamines were admitted for further workup and management. Results During the study period (July 2015 to December 2017), a total of 20 children with urticaria needed admission for symptom control and further workup. There were 16 boys and 4 girls. The mean (SD) age of presentation was 6.5 years (±2.4). Besides urticaria in all, pain abdomen was present in 13 (65%) and fever in 6 (30%) children. Only one had arthritis. Skin biopsy performed in these children was suggestive of leukocytoclastic vasculitis. One child was ANA (anti-nuclear antibody) positive with low C3. All except three children required systemic steroid for symptom control along with other medications (anti-histamines). None had suffered any complication or relapse. Conclusions Urticaria vasculitis (most common cause being idiopathic) remains underdiagnosed because of the need of confirmation by biopsy, which might not always be attempted in every case. Though anti-histamines remain the main stay of treatment, adding short course oral steroid shortens the course once infection is ruled out.
荨麻疹是一种III型超敏反应，通常由感染、药物或食物引发。它通常在24小时内消退，不留任何残余损害，且无任何全身表现。荨麻疹性血管炎（UV）是一种临床病理状况，其定义为存在持续超过24小时的荨麻疹损害或与白细胞破碎性血管炎组织病理学特征相关的复发性荨麻疹发作。方法：这项回顾性研究在印度东部的一家三级护理教学机构进行，为期2年半。出现荨麻疹损害持续超过24小时且未自发消退或使用抗组胺药后未消退的儿童入院进行进一步检查和治疗。结果：在研究期间（2015年7月至2017年12月），共有20名患有荨麻疹的儿童因症状控制和进一步检查而入院。其中有16名男孩和4名女孩。平均（标准差）就诊年龄为6.5岁（±2.4）。除了所有人都有荨麻疹外，13名（65%）儿童有腹痛，6名（30%）儿童有发热。只有一名儿童有关节炎。对这些儿童进行的皮肤活检提示白细胞破碎性血管炎。一名儿童抗核抗体（ANA）阳性，C3水平低。除三名儿童外，所有儿童都需要使用全身性类固醇进行症状控制以及其他药物（抗组胺药）。无人出现任何并发症或复发。结论：荨麻疹性血管炎（最常见的原因是特发性）由于需要活检确诊，而在每种情况下并非总是进行活检，因此仍未得到充分诊断。尽管抗组胺药仍然是主要治疗方法，但在排除感染后添加短期口服类固醇可缩短病程。
