Urticaria in Children

What is Urticaria in Children?

Urticaria – groups of diseases in which a common symptom is an urticaria element on the skin and itching of different intensities, all elements are reversible. With these diseases, the vascular permeability of the microvasculature increases and acute edema develops in the area that surrounds these vessels.

Forms of urticaria in children:

  • acute (less than 6 weeks)
  • chronic (more than 6 weeks)

Types of urticaria in children:

  • allergic
  • dermatographic
  • idiopathic
  • vibrating
  • temperature (caused by exposure to low or high temperature)
  • contact
  • cholinergic
  • unspecified
  • another
  • Quincke’s edema (angioedema)

Allergic urticaria is an allergic disease in children and adults, which is manifested by urticaria on the skin. This type of urticaria can be caused by medication, food, plant pollen, hymenoptera poison, or house dust.

Allergic urticaria in children often appears with respiratory allergies – bronchial asthma or allergic rhinitis.

Idiopathic urticaria is a disease of unknown origin, which is characterized by urticaria on the skin. Rashes are often torpid to standard antiallergic therapy, the course is persistent.

Temperature urticaria is a disease that is caused by exposure to low and high temperatures on the body. The character may be generalized or localized. Rashes are accompanied by an itch. Quincke’s edema often appears along with this disease.

Cholinergic urticaria is a disease that manifests itself in small, urtical multiple elements on the skin of a child. The most common cause is physical activity.

Dermatographic urticaria is a disease in which linear urinary elements and hyperemia appear on the skin. The cause is always mechanical irritation. The rash is localized in the skin folds or places where the child is crushed by clothing.

Vibratory urticaria is a rare type of urticaria caused by mechanical vibration.

Contact urticaria is a type of urticaria that can be caused by many pharmacological, biological, and other causes. With this disease, it is important to eliminate contact with the aggravating factor and prescribe a diet without including possible allergens in the diet.

Causes of Urticaria in Children

Acute urticaria is more common in children with atopic diseases. Urticaria in children can cause nutritional causes. This is the use of milk, wheat, eggs, seafood, fruits, honey, nuts, citrus fruits, food additives and smoked products.

Urticaria can be triggered by the use of drugs: antibiotics, sulfonamides, non-steroidal anti-inflammatory drugs, radiopaque drugs, B vitamins, anticonvulsants.

The causes of urticaria in children can be:

  • herpes simplex virus type 1;
  • hepatitis B, C viruses;
  • Coxsackie viruses A and B;
  • mycoplasma;
  • chlamydia;
  • Yersinia;
  • helminths;
  • the simplest parasites;
  • wasps and bees;
  • pollen aeroallergens;
  • household allergens;
  • epidermal allergens.

The causes of pseudo-allergic urticaria can be drugs with histamine-liberating action, for example, antihypertensive drugs, antimicrobial drugs, calcium antagonists, etc.

Pathogenesis during Urticaria in Children

Allergic urticaria appears in children, which makes the body hypersensitive to exogenous and endogenous allergens.

Stages of pathogenesis of allergic urticaria:

  1. sensitization to allergen
  2. secondary hyperergic reaction on repeated contact

Pseudoallergic urticaria occurs when, when exposed to chemical or physical factors, mast cells degranulate and release mediators that cause an urticarial reaction in the skin.

Varieties of pseudoallergic urticaria:

  • cholinergic
  • aquagenic
  • adrenergic

Cholinergic urticaria in children is caused by exercise, and aquagenic urticaria is caused by contact with water. Adrenergic appears after nervous stress.

Mixed urticaria can be:

  • pigmented
  • Sweet’s syndrome

Symptoms of Urticaria in Children

Among the most striking symptoms of urticaria in children is a rash in the form of “nodules” of red or light pink shades. The rash can be irregular and sometimes has a tendency to merge. In a child, the places of the rash are itchy, a bloody crust forms at the places of the rash. The appearance of the rash, like its disappearance, is unexpected. After the rash disappears, no marks remain on the skin.

Diagnostics of the Urticaria in Children

A general urine test, a clinical blood test is mandatory. It is necessary to pass a biochemical blood test, which will show the level of total protein, direct and total bilirubin, ATC, ALT, creatinine, blood glucose, uric acid. Also, in most cases, doctors prescribe laboratory diagnostics of RW, HIV, coprogram.

For idiopathic, unspecified, dermatographic urticaria, the above studies are carried out, as well as:

  • Bacteriological examination (feces, material from the mucous membranes of the oropharynx)
  • Rheumatological tests
  • Differentiated detection of AT to Ag toxocara, echinococcus, opisthorchis, trichinella and (or) other parasites
  • Coprovocystoscopy

Allergic examination includes:

  • prick and skin prick tests with atopic allergens and intradermal tests with infectious allergens
  • allergic history
  • in vitro or in vivo tests (if drug-induced urticaria is suspected)
  • tests: thermal, cold, with a tourniquet

Possible instrumental studies for suspected urticaria in children:

  • veloergometry (allows to exclude the cholinergic form of urticaria)
  • EGDS
  • ECG
  • Ultrasound of the abdominal organs
  • radiography of OGK and PPN

Consultations of such specialists are possible (depending on the manifestations of urticaria): allergist, rheumatologist, gynecologist, otolaryngologist, dentist, endocrinologist. When diagnosing, doctors take into account that urticaria is a symptom of not only urticaria, but also parasitic, autoimmune, oncological, gastrointestinal diseases, as well as chronic inflammatory diseases.

Treatment of Urticaria in Children

Allergic urticaria
The child is prescribed a hypoallergenic diet according to A.D. Ado. Food allergens, to which the body and histaminoliberator products react, should be excluded from the diet. Prescribing drugs depends on how severe the urticaria is.

With an exacerbation of a severe urticaria, some of the following drugs are taken (as prescribed by a doctor):

  • clemastine
  • chloropyramine 2.5% (course 5-7 days)
  • glucocorticosteroids of systemic action (if the above drugs were ineffective): dexamethasone, prednisolone
  • according to indications of hemodez 200-400 ml intravenous drip, 3-4 injections
  • fexofenadine (telfast)
  • loratadine (claritin) once a day
  • ketotifen

For the treatment of exacerbations of moderate urticaria take:

  • clemastine (tavegil) 0.1%
  • chloropyramine (suprastin) 2.5%
  • glucocorticosteroids of systemic action (according to indications)
  • fexofenadine
  • loratadine
  • ketotifen (zaditen) 0.001 g 2 times a day

With a mild course of exacerbations of urticaria, elimination measures are taken. Glucocorticosteroids are not used. Then fexofenadine (Telfast) and loratadine are used once a day. The course is 1 month. Ketotifen is taken in a course of 3 months.

Hospital treatment – 18-20 days. If necessary, carry out SIT, a course of histaglobulin in an allergy hospital or office.

Idiopathic urticaria
To treat this type of urticaria, the child must follow a hypoallergenic diet according to A.D. Ado. The same medications are recommended as in the treatment of exacerbations of moderate urticaria. With torpidity to symptomatic therapy, the child may be prescribed long-acting glucocorticosteroids for a course of 2-3 weeks.

Detoxification therapy involves the introduction of hemodesis 400 mg, the intake of sorbents. Digestive enzymes, such as mezim or festal, are attributed to the child, but not in all cases. Based on the identified pathology, the child is prescribed symptomatic treatment: antifungal, antibacterial, etc.

If treatment with antihistamines is effective, then a course of histaglobulin follows.

Temperature urticaria
As with the above types of urticaria, the child follows a diet according to A.D. Ado. A gentle thermal regime should be adhered to, avoiding high and too low temperatures. If the effect of thermal factors on the body is unavoidable, antihistamines should be taken before contact. With the phenomena of photodermatosis, photosensitizing drugs are canceled.

In the generalized form, take clemastine 0.1% 2 ml, chloropyramine (suprastin) 2.5%, dexamethasone, prednisone. In case of mild, moderate course, fexofenadine and loratadine are taken once a day. Doctors can also prescribe antihistamines with a stabilizing effect on mast cell membranes.

Cholinergic urticaria
The hypoallergenic diet described above is recommended for sick children. Limit physical activity. Drug therapy includes the introduction of a 0.1% solution of atropine sulfate under the skin, taking bellataminal, bellaspon, belloid – 1 tablet 3 times a day. The course is 1 month. Symptoms are also treated.

Dermatographic urticaria
Treatment begins with a diet according to AD Ado, excluding the effects of a mechanical factor. They are taking the third and second generation antihistamines mentioned above. The course is 2 months maximum. Also, doctors can prescribe ketotifen 1 mg 2 times a day, the course is half a year.

For treatment, it is necessary to take digestive enzymes: enzistal, festal, etc., if there is an indication for this. The revealed pathology is treated.

Prevention of Urticaria in Children

  1. Eliminate contact with the allergen
  2. Conduct maintenance courses to reduce allergic sensitivity
  3. Exclude from the diet foods to which an allergic reaction occurs
  4. Eat with care outside the home
  5. Study the label before buying and consuming products
  6. Do not use drugs for the treatment of any diseases to which the child is allergic
  7. Treat diseases of the nervous system in time