Management of urticaria and angioedema in children: New trends

Urticaria in childhood is a common problem. History of development of urticaria should be carefully taken from a written history/information list. For urticaria, the EAACI/GALEN/EDF consensus guidelines on definition, classification, diagnosis and management of urticaria should be considered. Soon an updated version of a new consensus will appear. The new classification of urticaria includes 3 main groups: spontaneous or idiopathic urticaria (divided in acute <6 weeks and chronic urticaria ≥6 weeks), physical urticaria (cold contact urticaria, delayed pressure urticaria) and other urticaria disorders such as aquagenic urticaria. In general aspects, there is no difference between children and adults, except some details. In children most urticaria are acute idiopathic or physical of character. Also, urticarial flares in atopic dermatitis in young children are common as manifestation of food allergy First step of treatment is directed to the cause (that is difficult in chronic urticaria) and triggering factors. The currently recommended first line treatment is application of oral nonsedating H1 antihistamines. If needed, the dosage of antihistamines should be up to two-fold (in adults four-fold), although evidence is lacking for this, whereas alternative treatment should be reserved as add-on therapy for unresponsive patients.