Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Expert Rev Clin Immunol. 2022 Sep;18(9):889-899. doi: 10.1080/1744666X.2022.2101999. Epub 2022 Jul 19.
Chronic urticaria (CU) appears with daily or intermittent/recurrent wheals with/without angioedema for more than six weeks. When no specific eliciting factors are found, chronic urticaria is defined as spontaneous (CSU). Up to 50% of patients with CSU do not respond to therapy, leading to a prolonged disease course and the need for expensive therapies, impacting the quality of life (QoL) and healthcare resources.
Diagnosis of CSU is made when other potential causes of chronic urticaria are excluded. CSU therapy aims to achieve complete control of symptoms and normalization of QoL. Current treatment options for urticaria aim to target mast cell mediators such as histamine, or activators, such as autoantibodies. Guidelines recommend starting with second generation antihistamines (sgAHs) and adding omalizumab therapy if symptoms are not controlled. This review aims to provide a practical guide for CSU in the pediatric population.
Treatment options for pediatric CSU are primarily based on adult data that have been extrapolated for children. Current guidelines should be reevaluated based on pediatric data, new biological treatments, and the COVID-19 pandemic. Future research is needed to investigate strategies to personalize current treatments and identify potential predictive biomarkers.
慢性荨麻疹（CU）表现为每天或间歇性/复发性风团伴/不伴血管性水肿超过 6 周。当未发现明确诱发因素时，将慢性荨麻疹定义为自发性（CSU）。多达 50%的 CSU 患者对治疗无反应，导致疾病持续时间延长，需要昂贵的治疗，影响生活质量（QoL）和医疗资源。
当排除其他潜在的慢性荨麻疹病因后，即可诊断为 CSU。CSU 的治疗旨在实现症状完全控制和 QoL 正常化。目前的荨麻疹治疗选择旨在针对肥大细胞介质，如组胺，或激活剂，如自身抗体。指南建议首先使用第二代抗组胺药（sgAHs），如果症状未得到控制，则添加奥马珠单抗治疗。本综述旨在为儿科人群中的 CSU 提供实用指南。
儿科 CSU 的治疗选择主要基于已外推至儿童的成人数据。应根据儿科数据、新的生物治疗方法和 COVID-19 大流行重新评估现行指南。需要开展未来研究以探讨策略，使现有治疗方法个体化，并确定潜在的预测生物标志物。
