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Management of Pediatric Chronic Spontaneous Urticaria: A Review of Current Evidence and Guidelines

Authors Chang J, Cattelan L, Ben-Shoshan M, Le M, Netchiporouk E

Received 16 November 2020

Accepted for publication 14 January 2021

Published 9 March 2021 Volume 2021:14 Pages 187—199


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Luis Garcia-Marcos

Jasmine Chang,1 Leila Cattelan,2 Moshe Ben-Shoshan,3 Michelle Le,2 Elena Netchiporouk2

1Department of Medicine, McGill University, Montreal, Quebec, Canada; 2Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada; 3Division of Allergy Immunology and Dermatology, Montreal Children’s Hospital, Montreal, Quebec, Canada

Correspondence: Elena Netchiporouk
Division of Dermatology, McGill University, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada
Email [email protected]

Abstract: Chronic urticaria (CU) is associated with debilitating symptoms such as pruritic wheals and/or angioedema, which can significantly affect patients’ sleep, productivity and quality of life. Chronic spontaneous urticaria (CSU) is defined in cases in which no triggering factor is identified. Various guidelines directing the optimal management of CU in the adult population were published and updated over the recent years with the most accepted and widely used being the EAACI/GA2LEN/EDF/WAO 2017 guidelines. Meanwhile, guidelines specific to the pediatric population are scarce, mainly due to the fact that high quality evidence is lacking for many treatment options in this age group. The objective of this article is to review and synthesize the existing literature regarding the management of pediatric CSU. Our review highlights evidence supporting the EAACI/GA2LEN/EDF/WAO 2017 treatment guidelines with non-sedating second-generation antihistamines (sgAHs) as the mainstay of treatment for pediatric CSU, considering their demonstrated efficacy and reassuring safety profile. Additionally, the use of omalizumab in adolescents is well supported by the current literature. There is limited data available regarding the updosing of sgAHs, omalizumab in children with CSU under 12 years of age and the treatment with cyclosporine and leukotriene receptor antagonists (LTRAs) in pediatric patients of all ages. However, the results from currently available case series and case reports are promising for omalizumab and cyclosporine use in children with CSU, although large and well-designed randomized control trials (RCTs) assessing these treatment options are needed in order to formulate strong recommendations for their use. First-generation antihistamines (fgAHs) remain commonly used in pediatric CSU treatment despite a lack of studies assessing their efficacy and safety in the pediatric population and their widely known inferior safety profile compared to sgAHs.

Keywords: chronic spontaneous urticaria; CSU, chronic urticaria; CU, treatment, management, guidelines, children, pediatric

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