Miroslav Repko, Vladimír Pohanka, Beáta Šoltýsová
Background: Acute urticaria is defined as presence of specific skin efflorescences with a duration of less than 6 weeks. In childhood it is common, often it is not possible to determine its etiology. The most common known causes are acute respiratory infections or an allergic reaction to food, drugs and insects. The first line treatment options are second generation antihistamines. Depending on the effect, the usual dose is increased up to 4 times. The use of coritosteroids is controversial, reserved for severe and long-lasting symptoms. The theoretical part of the work is devoted to the definition and management of urticaria. In the practical part we present our own set of pediatric patients with acute urticaria.
Patients and methods: The group of patients was consisted of all children hospitalized for urticaria in the Pediatric department of the Hospital in Poprad in the period 2014 to 2018. We evaluated the basic laboratory parameters in patients, namely the level of total immunoglobulins of class E and the relative and absolute number of eosinophils. Based on the available documentation, we tried to determine the etiology of urticaria. In the patient management, we monitored the use of 1st and 2nd generation antihistamines and corticosteroids.
Results: The group was consisted of 182 patients (186 hospitalizations), 52% girls and 48% boys. There were 118 (63%) children in the 0-6 years age group, 27 (15%) in the 7-12 years age group and 41 (22%) patients older than 13 years. The median of total immunoglobulin class E level was 40.9 IU/ml (5-985 IU/ml). The median of absolute eosinophil count was 0.06x 10*9/l (0.001 - 0.49 x10*9/l), and the median of relative eosinophil count was 2% (0.3 - 14%). According to etiology, patients were divided into the following groups: 1. unknown cause 46%, 2. infection 26%, 3. allergic reaction to food 19%, 4. allergic reaction to drugs 4%, 5. allergic reaction to insects 4% and 6. histamine intolerance 1%. Up to 97.3% of patients received 1st generation antihistamines, 66.7% intravenous corticosteroids, 37.6% oral corticosteroids and 32.9% 2nd generation antihistamines.
Conclusion: The results of our work were consistent with the world literature in terms of age representation and etiology of acute urticaria. However, the diagnostic approach and especially the choice of therapeutic agents were more or less in contradiction with the current recommendations of the world allergy and dermatology societies.