Ensina Luis Felipe, Brandão Larissa Silva, Melo Ana Caroline Dela Bianca, Antila Martti, Ben-Shoshan Moshe, Solé Dirceu
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Universidade Federal de Pernambuco, Recife, PE, Brazil.
Rev Paul Pediatr. 2024 Dec 20;43:e2024107. doi: 10.1590/1984-0462/2025/43/2024107. eCollection 2024.
This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group.
Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents).
According to the current guideline's algorithm, the treatment of CU involves using high doses of antihistamines when there is no response with the licensed dosage. The effectiveness of this increase in children has been demonstrated with control rates ranging from 35% to 92%, with few studies addressing safety profiles. Omalizumab is approved for children over 12 years of age as a second step in the algorithm. Although more studies with children are needed to assess its effectiveness and safety, some data show complete control of symptoms in more than 80% of pediatric cases with no adverse effects, including in children under 12 years. When monitored closely, cyclosporine showed a good response rate in pediatric CU with few adverse events. Also, PROMs validated for this age can be helpful in clinical decisions, such as Urticaria Activity Score summed over 7 days, Urticaria Control Test, and Chronic Urticaria Quality of Life Questionnaire.
Collaborative studies are necessary to generate stronger evidence to support the guideline recommendations for children. The existing data indicate that these drugs are safe and effective for treatment when dose adjustments are made.
本文旨在综述当前儿童慢性荨麻疹（CU）治疗的疗效和安全性，以及该年龄组现有的患者报告结局指标（PROMs）。
由于儿童CU的研究较少，作者对过去十年在PubMed数据库中以英文、西班牙文和葡萄牙文发表的文章进行了非系统性综述。使用的关键词为（抗组胺药或奥马珠单抗或环孢素或治疗）以及（慢性荨麻疹）以及（儿童或青少年）。
根据当前指南的算法，当按许可剂量治疗无反应时，CU的治疗包括使用高剂量抗组胺药。在儿童中这种增加剂量治疗的有效性已得到证实，控制率在35%至92%之间，很少有研究涉及安全性。奥马珠单抗被批准用于12岁以上儿童，作为该算法中的第二步。虽然需要更多针对儿童的研究来评估其有效性和安全性，但一些数据显示，超过80%的儿科病例症状得到完全控制，且无不良反应，包括12岁以下儿童。密切监测时，环孢素在儿童CU中显示出良好的反应率，不良事件较少。此外，针对该年龄组验证的PROMs有助于临床决策，如7天累计荨麻疹活动评分、荨麻疹控制测试和慢性荨麻疹生活质量问卷。
需要开展合作研究以产生更有力的证据来支持针对儿童的指南建议。现有数据表明，这些药物在进行剂量调整后治疗是安全有效的。
