Recurrent urticaria

Urticaria is characterized by the sudden development of wheals and/or angioedema. Acute urticaria is common, affecting 4.5–15% of British children. About 1/3 will progress to chronic or recurrent urticaria. 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 the most common form in children, usually secondary to a viral infection +/− antibiotic use. Viral infections are usually responsible for flare-ups. In older children, chronic spontaneous urticaria may be associated with antibodies to the α-chain of the high-affinity IgE receptor or, less commonly, other autoimmune disease. Dermographism and cold contact urticaria are the most common forms of physical urticaria in childhood.Symptomatic relief is usually achieved by elimination of triggers and non-sedating antihistamines. Unresponsive cases improve with the addition of leukotriene receptor antagonists, ciclosporin A or systemic immunosuppression. Short courses of oral steroids are helpful to control acute episodes and severe exacerbations of chronic urticaria.Urticaria remits over time. After 3 years, a third of children with chronic spontaneous urticaria are disease free and the vast majority will be disease free after 7 years.