Recurrent urticaria

Urticaria is characterized by the sudden development of wheals and/or angioedema. It is a common problem. Acute spontaneous urticaria is the most common form of urticaria, affecting up to 1 in 7 British children. About one-third will progress to chronic or recurrent urticaria. This article highlights the value of a good history and reviews the treatment options available for children.The diagnosis is usually made on clinical grounds, by a thorough history of eliciting factors. Further investigations should be guided by the urticaria subtype and are often unnecessary. Acute spontaneous urticaria is usually secondary to a viral infection ± antibiotic use. Viral infections are usually responsible for flare-ups. In older children, chronic spontaneous urticaria may by associated with antibodies to the α chain of the high-affinity IgE receptor or, less commonly, other autoimmune disease. Dermographism and cold urticaria are the commonest forms of inducible urticaria in childhood.Symptomatic relief is usually achieved by elimination of triggers and the use of non-sedating antihistamines. Tranexamic acid is useful to control isolated angioedema. Unresponsive cases may improve with the addition of a leukotriene receptor antagonist, anti IgE therapy or systemic immunosuppression (e.g. Ciclosporin A). Short courses of oral steroids are helpful to control acute episodes and severe exacerbations of chronic spontaneous urticaria. Urticaria remits over time. After 3 years, a quarter of children with chronic spontaneous urticaria are disease free and the vast majority are disease free after 7 years.