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Current Approach to the Dıagnosıs and Treatment of Chronıc Urticaria in Children

Year 2018, Volume: 10 Issue: 2, 1 - 6, 06.03.2018

Abstract

Abstract

Chronic urticaria is an important disase can affect the quality of life. It is less common in children than adults. Angioedema is accompanied urticaria in an importantpart of the cases.  Chronic urticaria, is grouped under two main headings as chronicspontaneous urticaria and chronic inducible urticaria. Urticaria should be distinguished from other urticaria forms which belong systemic diseases caused by differentpathological mechanisms. The first step in treatment is to avoid trigger factors. Themost commonly used drugs in medical treatment are second-generation antihistamines. If there is no response to antihistamine treatment, the dose should be increased.If no response is obtained, additional treatment options such as omalizumab, montelukast and cyclosporin A should be considered.

References

  • Kaynaklar 1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Ca-nonica GW, et al. European Academy of Allergy and Clinical Im-munology; Global Allergy and Asthma European Network; Eu-ropean Dermatology Forum; World Allergy Organization. TheEAACI/GA(2)LEN/EDF/WAO Guideline for the definition, clas-sification, diagnosis, and management of urticaria: the 2013 re-vision and update. Allergy. 2014;69:868-87. 2. Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, NusemD, Panasoff J. Clinical and laboratory parameters in predictingchronic urticaria duration: a prospective study of 139 patients.Allergy. 2004;59(8):869-73. 3. Göncü EK, Aktan Ş, Atakan N, Bülbül Başkan E, Erdem T, KocaR, et al. All Authors Have Contributed On An Equal Basis To ThisArticle. The Turkish Guideline for the Diagnosis and Manage-ment of Urticaria-2016. TURKDERM. 2016; 50(3): 82-98. 4. Wedi B: Urticaria. J Dtsch Dermatol Ges 2008;6:306-17.5. Church MK, Weller K, Stock P, Maurer M Pediatr Allergy Im-munol. 2011; 22:1-8. 6. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F,et al. The diagnosis and management of acute and chronic urti-caria: 2014 update. J Allergy Clin Immunol. 2014;133:1270–7. 7. Khakoo G, Sofianou-Katsoulis A, Perkin MR, Lack G. Clinicalfeatures and natural history of physical urticaria in children. Pe-diatr Allergy Immunol. 2008; 19(4):363-6. 8. Lee SJ, Ha EK, Jee HM, Lee KS, Lee SW, Kim MA, et al. Pre-valence and Risk Factors of Urticaria With a Focus on ChronicUrticaria in Children. Allergy Asthma Immunol Res.2017;9:212–9. 9. O’Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW.The impact of chronic urticaria on the quality of life. Br J Der-matol 1997;136:197–201. 10. Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specc-hia C, et al. Quality of life and patients’ satisfaction in chronicurticaria and respiratory allergy. Allergy 2003;58:621–3. 11. Ventura MT, Napolitano S, Menga R, Cecere R, Asero R. Anisakissimplex hypersensitivity is associated with chronic urticaria in en-demic areas. Int Arch Allergy Immunol 2013;160:297–300. 12. Zuberbier T, Chantraine-Hess S, Hartmann K, Czarnetzki BM.Pseudoallergen-free diet in the treatment of chronic urticaria –a prospective study. Acta Derm Venereol 1995;75:484–7. 13. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Grea-ves MW. Autoantibodies against the high-affinity IgE receptor asa cause of histamine-release in chronic urticaria. N Engl J Med1993;328:1599–604. 14. Brunetti L, Francavilla R, Miniello VL, Platzer MH, Rizzi D, Los-palluti ML, et al. High prevalence of autoimmune urticaria in child-ren with chronic urticaria. J Allergy Clin Immunol.2004;114:922–7. 15. Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Vi-sitsunthorn N, Vichyanond P. Identification of the etiologies ofchronic urticaria in children: a prospective study of 94 patients.Pediatr Allergy Immunol.2010;21:508–514. 16. Kilic G, Guler N, Suleyman A, Tamay Z. Chronic urticaria andautoimmunity in children. Pediatr Allergy Immunol. 2010Aug;21(5):837-42. 17. ahiner UM, Civelek E, Tuncer A, Yavuz ST, Karabulut E, SackesenC, Sekerel BE. Chronic urticaria: etiology and natural course in child-ren. Int Arch Allergy Immunol. 2011;156(2):224-30. 18. Cavkaytar O, Arik Yilmaz E, Buyuktiryaki B, Sekerel BE, Sacke-sen C, Soyer OU. Challenge-proven aspirin hypersensitivity inchildren with chronic spontaneous urticaria. Allergy.2015;70:153–160. 19. Movahedi M, Tavakol M, Hirbod-Mobarakeh A, Gharagozlou M,Aghamohammadi A, Tavakol Z, et al. Vitamin D deficiency in chro-nic idiopathic urticaria. Iran J Allergy Asthma Immunol.2015;14:222–227. 20. Rorie A, Goldner WS, Lyden E, Poole JA. Beneficial role for supp-lemental vitamin D3 treatment in chronic urticaria: a randomizedstudy. Ann Allergy Asthma Immunol. 2014;112:376–82. 21. Shin M, Lee S. Prevalence and Causes of Childhood Urticaria. Al-lergy, Asthma & Immunology Research. 2017;9(3):189-90. 22. Choi SH, Baek HS. Approaches to the diagnosis and managementof chronic urticaria in children. Korean J Pediatr. 2015;58(5):159-64. 23. Pfrommer C, Bastl R, Vieths S, Ehlers I, Henz BM, Zuberbier T.Characterization of naturally occurring pseudoallergens causingchronic urticaria. J Allergy Clin Immunol 1996;97:367. 24. Bunselmeyer B, Laubach HJ, Schiller M, Stanke M, Luger TA,Brehler R. Incremental build-up food challenge–a new diagnos-tic approach to evaluate pseudoallergic reactions in chronic ur-ticaria: a pilot study: stepwise food challenge in chronic urtica-ria. Clin Exp Allergy 2009;39:116–26. 25. Bailey E, Shaker M. An update on childhood urticaria and an-gioedema. Curr Opin Pediatr 2008;20:425–30. 26. Novembre E, Cianferoni A, Mori F, Barni S, Calogero C, Ber-nardini R et al. Urticaria and urticaria related skin condition/di-sease in children. Eur Ann Allergy Clin Immunol 2008;40:5–13. 27. Ehlers I, Niggemann B, Binder C, Zuberbier T. Role of nonaller-gic hypersensitivity reactions in children with chronic urticaria.Allergy 1998;53:1074–7. 28. Legrain V, Taieb A, Sage T, Maleville J. Urticaria in infants: astudy of forty patients. Pediatr Dermatol 1990;7:101–7. 29. Kang HS, Shin MY. Clinical aspects of chronic urticaria in child-ren. Korean J Pediatr. 2009;52:205–12. 30. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, PacharnP, Visitsunthorn N, Vichyanond P, et al. The natural history ofchronic urticaria in childhood: a prospective study. J Am AcadDermatol. 2014;71:663–8. 31. Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT;British Society for Allergy and Clinical Immunology. BSACI gui-deline for the management of chronic urticaria and angioedema.Clin Exp Allergy. 2015;45(3):547-65. 32. Magerl M, Staubach P, Altrichter S, Ardelean E, Krause K, MetzM et al. Effective treatment of therapy-resistant chronic sponta-neous urticaria with omalizumab. J Allergy Clin Immunol2010;126:665–6. 33. Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A etal. A randomized, placebo-controlled, dose-ranging study of sin-gle-dose omalizumab in patients with H-1-antihistamine-refrac-tory chronic idiopathic urticaria. J Allergy Clin Immunol2011;128:567–73. 34. Groffik A, Mitzel-Kaoukhov H, Magerl M, Maurer M, StaubachP. Omalizumab – an effective and safe treatment of therapyre-sistant chronic spontaneous urticaria. Allergy 2011;66:303–5. 35. Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Mau-rer M, et al. Omalizumab rapidly improves angioedema-related qua-lity of life in adult patients with chronic spontaneous urticaria: X-ACT study data. Allergy. 2018;73(3):576-84. 36. Metz M, Bergmann P, Zuberbier T, Maurer M. Successful treat-ment of cholinergic urticaria with anti-immunoglobulin E therapy.Allergy 2008;63:247–9. 37. Boyce JA. Successful treatment of coldinduced urticaria/anaphy-laxis with anti-IgE. J Allergy Clin Immunol 2006;117:1415–8. 38. Guzelbey O, Ardelean E, Magerl M, Zuberbier T, Maurer M, MetzM. Successful treatment of solar urticaria with anti-immunoglo-bulin E therapy. Allergy 2008;63:1563–5. 39. Bullerkotte U, Wieczorek D, Kapp A, Wedi B. Effective treatmentof refractory severe heat urticaria with omalizumab. Allergy2010;65:931–2. 40. Krause K, Ardelean E, Kessler B, Magerl M, Metz M, Siebenha-ar F et al. Antihistamine-resistant urticaria factitia successfullytreated with anti-immunoglobulin E therapy. Allergy2010;65:1494–5. 41. Bindslev-Jensen C, Skov PS. Efficacy of omalizumab in delayedpressure urticaria: a case report. Allergy 2010;65:138–9. 42. Metz M, Altrichter S, Ardelean E, Kessler B, Krause K, MagerlM et al. Anti-immunoglobulin E treatment of patients with recal-citrant physical urticaria. Int Arch Allergy Immunol2011;154:177–80. 43. 45. Stellato C, de Paulis A, Ciccarelli A, Cirillo R, Patella V, Ca-solaro V et al. Anti-inflammatory effect of cyclosporin A on hu-man skin mast cells. J Invest Dermatol 1992;98:800–4. 44. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW.Plasmapheresis for severe, unremitting, chronic urticaria. Lan-cet 1992;339:1078–80.

Çocukluk Çağında Kronik Ürtiker'e Tanı ve Tedavi Yaklaşımı

Year 2018, Volume: 10 Issue: 2, 1 - 6, 06.03.2018

Abstract

Öz

Kronik ürtiker hayat kalitesini etkileyebilen önemli bir hastalıktır. Çocuklarda erişkinlere oranlara daha nadir görülmektedir. Olguların önemli bir kısmında ürtikere anjioödem eşlik etmektedir. Kronik ürtiker; kronik spontan ürtiker ve kronik indüklenebilir ürtiker olmak üzere iki ana başlık altında gruplandırılmaktadır. Ayırıcı tanıda, ürtikerin bulgularından bir parçası olduğu farklı patolojik mekanizmalarla oluşan sistemik hastalıklardan ayırt edilmelidir. Tedavide ilk basamak tetikleyici faktörlerden uzak durmaktır. Medikal tedavide en çok kullanılan ilaçlar ikinci kuşak an-tihistaminiklerdir. Antihistaminik tedavisine yanıt alınmadığında doz artımına gidilmeli ve yine yanıt alınamazsa omalizumab, montelukast ve siklosporin A gibi ek tedavi seçenekleri düşünülmelidir. 

References

  • Kaynaklar 1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Ca-nonica GW, et al. European Academy of Allergy and Clinical Im-munology; Global Allergy and Asthma European Network; Eu-ropean Dermatology Forum; World Allergy Organization. TheEAACI/GA(2)LEN/EDF/WAO Guideline for the definition, clas-sification, diagnosis, and management of urticaria: the 2013 re-vision and update. Allergy. 2014;69:868-87. 2. Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, NusemD, Panasoff J. Clinical and laboratory parameters in predictingchronic urticaria duration: a prospective study of 139 patients.Allergy. 2004;59(8):869-73. 3. Göncü EK, Aktan Ş, Atakan N, Bülbül Başkan E, Erdem T, KocaR, et al. All Authors Have Contributed On An Equal Basis To ThisArticle. The Turkish Guideline for the Diagnosis and Manage-ment of Urticaria-2016. TURKDERM. 2016; 50(3): 82-98. 4. Wedi B: Urticaria. J Dtsch Dermatol Ges 2008;6:306-17.5. Church MK, Weller K, Stock P, Maurer M Pediatr Allergy Im-munol. 2011; 22:1-8. 6. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F,et al. The diagnosis and management of acute and chronic urti-caria: 2014 update. J Allergy Clin Immunol. 2014;133:1270–7. 7. Khakoo G, Sofianou-Katsoulis A, Perkin MR, Lack G. Clinicalfeatures and natural history of physical urticaria in children. Pe-diatr Allergy Immunol. 2008; 19(4):363-6. 8. Lee SJ, Ha EK, Jee HM, Lee KS, Lee SW, Kim MA, et al. Pre-valence and Risk Factors of Urticaria With a Focus on ChronicUrticaria in Children. Allergy Asthma Immunol Res.2017;9:212–9. 9. O’Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW.The impact of chronic urticaria on the quality of life. Br J Der-matol 1997;136:197–201. 10. Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specc-hia C, et al. Quality of life and patients’ satisfaction in chronicurticaria and respiratory allergy. Allergy 2003;58:621–3. 11. Ventura MT, Napolitano S, Menga R, Cecere R, Asero R. Anisakissimplex hypersensitivity is associated with chronic urticaria in en-demic areas. Int Arch Allergy Immunol 2013;160:297–300. 12. Zuberbier T, Chantraine-Hess S, Hartmann K, Czarnetzki BM.Pseudoallergen-free diet in the treatment of chronic urticaria –a prospective study. Acta Derm Venereol 1995;75:484–7. 13. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Grea-ves MW. Autoantibodies against the high-affinity IgE receptor asa cause of histamine-release in chronic urticaria. N Engl J Med1993;328:1599–604. 14. Brunetti L, Francavilla R, Miniello VL, Platzer MH, Rizzi D, Los-palluti ML, et al. High prevalence of autoimmune urticaria in child-ren with chronic urticaria. J Allergy Clin Immunol.2004;114:922–7. 15. Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Vi-sitsunthorn N, Vichyanond P. Identification of the etiologies ofchronic urticaria in children: a prospective study of 94 patients.Pediatr Allergy Immunol.2010;21:508–514. 16. Kilic G, Guler N, Suleyman A, Tamay Z. Chronic urticaria andautoimmunity in children. Pediatr Allergy Immunol. 2010Aug;21(5):837-42. 17. ahiner UM, Civelek E, Tuncer A, Yavuz ST, Karabulut E, SackesenC, Sekerel BE. Chronic urticaria: etiology and natural course in child-ren. Int Arch Allergy Immunol. 2011;156(2):224-30. 18. Cavkaytar O, Arik Yilmaz E, Buyuktiryaki B, Sekerel BE, Sacke-sen C, Soyer OU. Challenge-proven aspirin hypersensitivity inchildren with chronic spontaneous urticaria. Allergy.2015;70:153–160. 19. Movahedi M, Tavakol M, Hirbod-Mobarakeh A, Gharagozlou M,Aghamohammadi A, Tavakol Z, et al. Vitamin D deficiency in chro-nic idiopathic urticaria. Iran J Allergy Asthma Immunol.2015;14:222–227. 20. Rorie A, Goldner WS, Lyden E, Poole JA. Beneficial role for supp-lemental vitamin D3 treatment in chronic urticaria: a randomizedstudy. Ann Allergy Asthma Immunol. 2014;112:376–82. 21. Shin M, Lee S. Prevalence and Causes of Childhood Urticaria. Al-lergy, Asthma & Immunology Research. 2017;9(3):189-90. 22. Choi SH, Baek HS. Approaches to the diagnosis and managementof chronic urticaria in children. Korean J Pediatr. 2015;58(5):159-64. 23. Pfrommer C, Bastl R, Vieths S, Ehlers I, Henz BM, Zuberbier T.Characterization of naturally occurring pseudoallergens causingchronic urticaria. J Allergy Clin Immunol 1996;97:367. 24. Bunselmeyer B, Laubach HJ, Schiller M, Stanke M, Luger TA,Brehler R. Incremental build-up food challenge–a new diagnos-tic approach to evaluate pseudoallergic reactions in chronic ur-ticaria: a pilot study: stepwise food challenge in chronic urtica-ria. Clin Exp Allergy 2009;39:116–26. 25. Bailey E, Shaker M. An update on childhood urticaria and an-gioedema. Curr Opin Pediatr 2008;20:425–30. 26. Novembre E, Cianferoni A, Mori F, Barni S, Calogero C, Ber-nardini R et al. Urticaria and urticaria related skin condition/di-sease in children. Eur Ann Allergy Clin Immunol 2008;40:5–13. 27. Ehlers I, Niggemann B, Binder C, Zuberbier T. Role of nonaller-gic hypersensitivity reactions in children with chronic urticaria.Allergy 1998;53:1074–7. 28. Legrain V, Taieb A, Sage T, Maleville J. Urticaria in infants: astudy of forty patients. Pediatr Dermatol 1990;7:101–7. 29. Kang HS, Shin MY. Clinical aspects of chronic urticaria in child-ren. Korean J Pediatr. 2009;52:205–12. 30. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, PacharnP, Visitsunthorn N, Vichyanond P, et al. The natural history ofchronic urticaria in childhood: a prospective study. J Am AcadDermatol. 2014;71:663–8. 31. Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT;British Society for Allergy and Clinical Immunology. BSACI gui-deline for the management of chronic urticaria and angioedema.Clin Exp Allergy. 2015;45(3):547-65. 32. Magerl M, Staubach P, Altrichter S, Ardelean E, Krause K, MetzM et al. Effective treatment of therapy-resistant chronic sponta-neous urticaria with omalizumab. J Allergy Clin Immunol2010;126:665–6. 33. Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A etal. A randomized, placebo-controlled, dose-ranging study of sin-gle-dose omalizumab in patients with H-1-antihistamine-refrac-tory chronic idiopathic urticaria. J Allergy Clin Immunol2011;128:567–73. 34. Groffik A, Mitzel-Kaoukhov H, Magerl M, Maurer M, StaubachP. Omalizumab – an effective and safe treatment of therapyre-sistant chronic spontaneous urticaria. Allergy 2011;66:303–5. 35. Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Mau-rer M, et al. Omalizumab rapidly improves angioedema-related qua-lity of life in adult patients with chronic spontaneous urticaria: X-ACT study data. Allergy. 2018;73(3):576-84. 36. Metz M, Bergmann P, Zuberbier T, Maurer M. Successful treat-ment of cholinergic urticaria with anti-immunoglobulin E therapy.Allergy 2008;63:247–9. 37. Boyce JA. Successful treatment of coldinduced urticaria/anaphy-laxis with anti-IgE. J Allergy Clin Immunol 2006;117:1415–8. 38. Guzelbey O, Ardelean E, Magerl M, Zuberbier T, Maurer M, MetzM. Successful treatment of solar urticaria with anti-immunoglo-bulin E therapy. Allergy 2008;63:1563–5. 39. Bullerkotte U, Wieczorek D, Kapp A, Wedi B. Effective treatmentof refractory severe heat urticaria with omalizumab. Allergy2010;65:931–2. 40. Krause K, Ardelean E, Kessler B, Magerl M, Metz M, Siebenha-ar F et al. Antihistamine-resistant urticaria factitia successfullytreated with anti-immunoglobulin E therapy. Allergy2010;65:1494–5. 41. Bindslev-Jensen C, Skov PS. Efficacy of omalizumab in delayedpressure urticaria: a case report. Allergy 2010;65:138–9. 42. Metz M, Altrichter S, Ardelean E, Kessler B, Krause K, MagerlM et al. Anti-immunoglobulin E treatment of patients with recal-citrant physical urticaria. Int Arch Allergy Immunol2011;154:177–80. 43. 45. Stellato C, de Paulis A, Ciccarelli A, Cirillo R, Patella V, Ca-solaro V et al. Anti-inflammatory effect of cyclosporin A on hu-man skin mast cells. J Invest Dermatol 1992;98:800–4. 44. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW.Plasmapheresis for severe, unremitting, chronic urticaria. Lan-cet 1992;339:1078–80.
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Details

Primary Language Turkish
Journal Section makale
Authors

Uzm. Dr. Şükrü Çekiç

Publication Date March 6, 2018
Published in Issue Year 2018 Volume: 10 Issue: 2

Cite

APA Çekiç, U. D. Ş. (2018). Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı. Klinik Tıp Pediatri Dergisi, 10(2), 1-6.
AMA Çekiç UDŞ. Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı. Pediatri. March 2018;10(2):1-6.
Chicago Çekiç, Uzm. Dr. Şükrü. “Çocukluk Çağında Kronik Ürtiker’e Tanı Ve Tedavi Yaklaşımı”. Klinik Tıp Pediatri Dergisi 10, no. 2 (March 2018): 1-6.
EndNote Çekiç UDŞ (March 1, 2018) Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı. Klinik Tıp Pediatri Dergisi 10 2 1–6.
IEEE U. D. Ş. Çekiç, “Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı”, Pediatri, vol. 10, no. 2, pp. 1–6, 2018.
ISNAD Çekiç, Uzm. Dr. Şükrü. “Çocukluk Çağında Kronik Ürtiker’e Tanı Ve Tedavi Yaklaşımı”. Klinik Tıp Pediatri Dergisi 10/2 (March 2018), 1-6.
JAMA Çekiç UDŞ. Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı. Pediatri. 2018;10:1–6.
MLA Çekiç, Uzm. Dr. Şükrü. “Çocukluk Çağında Kronik Ürtiker’e Tanı Ve Tedavi Yaklaşımı”. Klinik Tıp Pediatri Dergisi, vol. 10, no. 2, 2018, pp. 1-6.
Vancouver Çekiç UDŞ. Çocukluk Çağında Kronik Ürtiker’e Tanı ve Tedavi Yaklaşımı. Pediatri. 2018;10(2):1-6.