Natural History And Predictors Of Recovery In Children With Chronic Spontaneous Urticaria

BACKGROUND Limited data are available about the natural history of chronic spontaneous urticaria in children (CSU), and management guidelines are mostly extrapolated from evidence in adults. METHODS The objective of this study was toevaluate the natural history of CSU in children and to identify predictors for remission. We performed an observational study, including patients aged 0 to 18 years with CSU diagnosed from January 2006 to July 2016. Disease activity was evaluated by the Urticaria Activity Score (UAS) and the Urticaria Activity Score 7 (UAS7); type of treatment and number of daily administrations were recorded. RESULTS Eighty patients were included in the study. At 1, 3, and 5 years from the onset of symptoms, 29%, 55%, and 72% of the patients with CSU were in remission, respectively. A higher hazard ratio of non-remission both at 3 years (HR=1.7, 95%CI=1.2-2.4, p-value 0.004) and at 5 years (HR=1.7, 95%CI=1.2-2.7, p-value 0.001), was related to higher severity of CSU at the baseline. Remission rates were significantly higher in patients who used a single dose of antihistamine drug (89% vs. 54% and 67% at 5 years, p-value=0.0003). During follow-up, four patients experienced a relapse (6.9%). The distance of relapses from remission varied from 2 to 5 years without evidence of a correlation between the age at the onset and the duration of the disease (Spearman\u0027s coefficient=0.02; p-value=0.9). CONCLUSION High UAS score at onset is a prognostic factor for the persistence of symptoms, as well as the need for multiple antihistamine drug doses per day or second-line treatments. Chronic urticaria (CU) is a relatively frequent disease with an estimated point prevalence of 0.7% around the world, subject to regional differences1 . Children seem to display a slightly higher frequency of the disease compared to adults, but to date, limited epidemiological data are available regardingthe paediatric age, with only a few studies specifically examining the Caucasian population Although it is considered a self-limited disease, CU often lasts for years. However, data on the natural historyof CU are lacking, particularly in children, and frequently are not specific to the different CU subtypes.Finally, management recommendations are mostly extrapolated from evidence in adults.