Main Article Content
Allergy, Children, Chronic, Urticaria
Background: Chronic spontaneous urticaria (CSU) is a disease that seriously disturbs the quality of life of the patient. Currently there is no prognostic marker of the disease. Our aim in this study was to determine possible prognostic markers of CSU in children.
Method: All patients younger than 18 years of age who were followed by the Pediatric Immunology and Allergy Clinic of Diyarbakir Children’s Hospital with a diagnosis of CSU between June 2017 and February 2019 were included in the study. Clinical and laboratory findings were compared between the symptomatic patient group and the patient group that remained in remission for at least three months without use of medication.
Results: Of the 52 cases included in the study, 32 (61.5%) were male. Mean age at time of diagnosis was 9.4 ± 4.4 years. Twenty four cases (46.2%) went into remission. Young age at the time of diagnosis and being in the initial months of the disease were found to be associated with good prognosis (p < 0.05). Among laboratory results, elevation in absolute neutrophil count and neutrophil/lymphocyte ratio (NLR) were found to be associated with poor prognosis (p < 0.05). NLR was positively correlated with disease duration (p < 0.05).
Conclusion: For childhood CSU, younger age and initial months of the disease are good prognostic indicators, while only neutrophil/lymphocyte count can be used as a remission marker.
2. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, Pacharn P, Visitsunthorn N, Vichyanond P, et al. The natural history of chronic urticaria in childhood: a prospective study. J Am Acad Dermatol. 2014;71:663-8.
3. Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66:317-30.
4. Hiragun M, Hiragun T, Mihara S, Akita T, Tanaka J, Hide M. Prognosis of chronic spontaneous urticaria in 117 patients not controlled by a standard dose of antihistamine. Allergy. 2013;68:229-35.
5. Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, Nusem D, et al. Clinical and laboratory parameters in predicting chronic urticarial duration: a prospective study of 139 patients. Allergy. 2004;59:869-73.
6. Arik Yilmaz E, Karaatmaca B, Cetinkaya PG, Soyer O, Sekerel BE, Sahiner UM. The persistence of chronic spontaneous urticaria in childhood is associated with the urticaria activity score. Allergy Asthma Proc. 2017;38(2):136-42.
7. Ferrante G, Scavone V, Muscia MC, Adrignola E, Corsello G, Passalacqua G, et al. The care pathway for children with urticaria, angioedema, mastocytosis. World Allergy Organ J. 2015;8(February (1)):5.
8. Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, et al. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr. 2019;45(August (1)):101.
9. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A. Subtypes of chronic urticaria in patients attending allergy clinics in Venezuela. Eur Ann Allergy Clin Immunol. 2014;46:2105.
10. Młynek A, Magerl M, Hanna M, Lhachimi S, Baiardini I, Canonica DW, et al. The German version of the Chronic Urticaria Quality-of-Life Questionnaire: factor analysis, validation, and initial clinical findings. Allergy. 2009;64:927-36.
11. Gregoriou S, Rigopoulos D, Katsambas A, Katsarou A, Papaioannou D, Grouri A, et al. Etiologic aspects and prognostic factors of patients with chronic urticaria: nonrandomized, prospective, descriptive study. J Cutan Med Surg. 2009;13:198---203.
12. Harris A, Twarog FJ, Geha RS. Chronic urticaria in childhood: natural course and etiology. Ann Allergy. 1983;51:161-5.
13. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, Pacharn P, Visitsunthorn N, Vichyanond P, et al. The natural history of chronic urticaria in childhood: a prospective study. J Am Acad Dermatol. 2014;71:663-8.
14. Sahiner UM, Civelek E, Tuncer A, Yavuz ST, Karabulut E, Sackesen C, et al. Chronic urticaria: etiology and natural course in children. Int Arch Allergy Immunol. 2011;156:224-30.
15. Gaig P, Olona M, Munoz ˜ Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, et al. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol. 2004;14:214-20.
16. Eser I, Yologlu N, Baydemir C, Aydogan M. The predictive factors for remission of chronic spontaneous urticaria in childhood: outcome from a prospective study. Allergol Immunopathol (Madr). 2016;44(6):537-41.
17. Kulthanan K, Jiamton S, Gorvanich T, Pinkaew S. Autologous serum skin test in chronic idiopathic urticaria: prevalence, correlation and clinical implications. Asian Pac J Allergy Immunol. 2006;24:201-6.
18. Staubach P, Onnen K, Vonend A, Metz M, Siebenhaar F, Tschentscher I, et al. Autologous whole blood injections to patients with chronic urticaria and a positive autologous serum skin test: a placebo-controlled trial. Dermatology. 2006;212:150-9.
19. Chanprapaph K, Iamsumang W, Wattanakrai P, Vachiramon V. Thyroid autoimmunity and autoimmunity in chronic spontaneous urticaria linked to disease severity, therapeutic response, and time to remission in patients with chronic spontaneous urticaria. BioMed Res Int. 2018;2018:9856843, http://dx.doi.org/10.1155/2018/9856843, 13 pages.
20. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L, Maurer M. Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2017;31:964-71.
21. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11:55-9.
22. Ye YM, Jin HJ, Hwang EK, Nam YH, Kim JH, Shin YS, et al. Coexistence of chronic urticaria and metabolic syndrome: clinical implications. Acta Derm Venereol. 2013;93:156-60.
23. Aleem S, Masood Q, Hassan I. Correlation of C-reactive protein levels with severity of chronic urticaria. Indian J Dermatol. 2014;59:636.
24. Grattan CE. Basophils in chronic urticaria. J Investig Dermatol Symp Proc. 2001;6:139-40.
25. Ye YM, Yang EM, Yoo HS, Shin YS, Kim SH, Park HS. Increased level of basophil CD203c expression predicts severe chronic urticaria. J Korean Med Sci. 2014;29:43-7.
26. Berti A, Yacou MR, Stahl Skov P, Falkencrone S, Casati L, Burastero S, et al. Histamine release positive test associates with disease remission in chronic spontaneous urticaria: a proof-of-concept study. Eur Ann Allergy Clin immunol. 2017;49:154-60.
27. Kessel A, Helou W, Bamberger E, Sabo E, Nusem D, Nusem J, et al. Elevated serum total IgE: a potential marker for severe chronic urticaria. Int Arch Allergy Immunol. 2010;153:288-93.