Evidence-Based Management of Chronic Urticaria in Children

Chronic urticaria (CU) in children is a distressful disorder that can often be challenging to treat. Elimination or treatment of eliciting stimulus is the first step in the management of CU; however, in the majority of cases, the cause remains unknown. According to currently available guidelines, H1-antihistamines are still first-line therapy for CU in children. Unfortunately, regularly approved doses relieve symptoms in <50% of patients, necessitating an up to 4-fold dose increase. However, in some patients, even high doses of H1-antihistamines fail to produce satisfactory results, leaving place for new therapeutic strategies in the treatment of CU; first to add either leukotriene antagonist or H2-antihistamine. In severe, unresponsive cases, other therapeutic approaches should be considered. However, it is important to be familiar with the possible side effects, because some of these approaches imply off-label use of drugs. This review presents a summary of the evidence on the treatment of CU in pediatric patients available up to January 2012.