Summary: Urticaria is a common condition in children, characterized by the development of wheals, angioedema or both. It is estimated to affect 15-20% of people at some point in their life. Most episodes are acute with a mean duration of symptoms ranging from 4 to 7 days.
Common triggers include infections, medications and food allergy. The clinical course of most cases are mild and symptoms resolve by themselves or upon treatment. The diagnosis is usually made on clinical grounds. Acute urticaria rarely warrants a battery of tests unless history or physical examination suggests a specific cause that needs to be confirmed.
The therapeutic approach can involve identification and elimination of the underlying causes and symptomatic treatment. Non-sedating second-generation antihistamines should be used as first-line therapy. In children with severe acute urticaria, short term-use of systemic corticosteroids might be indicated. The old sedating first-generation antihistamines should be avoided, mostly due to relevant side-effects. The duration of treatment is determined by individual predisposition, the suspected cause of urticaria and clinical response. Virus infections, drug hypersensitivity, coexistence of angioedema and personal allergic history appear to be risk factors of a more severe clinical course of urticaria.
It is important to distinguish acute urticaria from anaphylaxis, which is characterized by a sudden worsening in the patient’s condition and underlying life-threatening cardiovascular and respiratory symptoms.