Hospital admissions for urticaria in a pediatric emergency department of a tertiary care hospital

Inês Filipa da Costa Farinha; Helena Sofia Pires Aguiar Pereira; Sónia Cristina Gaspar de Lemos; Emília Maria Antunes Gomes de Faria; Fernanda Maria Pereira Rodrigues

doi:10.15586/aei.v51i3.820

Inês Filipa da Costa Farinha

Allergy and Clinical Immunology Department, Coimbra Hospital and University Center, Coimbra, Portugal.

Helena Sofia Pires Aguiar Pereira

Allergy and Clinical Immunology Department, Coimbra Hospital and University Center, Coimbra, Portugal.

Sónia Cristina Gaspar de Lemos

Allergy Unit, Pediatric Hospital, Coimbra Hospital and University Center, Coimbra, Portugal.

Emília Maria Antunes Gomes de Faria

Allergy and Clinical Immunology Department, Coimbra Hospital and University Center, Coimbra, Portugal.

Fernanda Maria Pereira Rodrigues

Emergency Service and Infeciology Unit, Pediatric Hospital, Coimbra Hospital and University Center, Coimbra, Portugal; University Clinic of Pediatrics, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.

Keywords

acute urticaria, chronic urticaria, emergency department, pediatric age, urticaria

Abstract

Background: Urticaria is a common disorder, estimated to affect 2.1 to 6.7% of children and adolescents, and is a frequent cause of emergency department (ED) admissions.

Methods: The aim of this study was to retrospectively characterize the clinical features of children and adolescents with a diagnosis of urticaria, evaluated in a tertiary care pediatric ED between 2015 and 2019. Statistical analysis was performed using IBM SPSS Statistics^®, version 27.0.

Results: A total of 2254 episodes of urticaria were counted with 98.1% corresponding to acute urticaria (AU). A suspected trigger factor was identified in 51.6% of the episodes, namely infections (27.8%), drugs (9.9%) and food (7.6%). From these episodes, excluding infections, only 59.2% were referred to an Allergy Consultation for further study, with only 18.8% (drug) and 28.3% (food) confirmed as the AU trigger. Of the 43 episodes of chronic urticaria (CU), 79% were referred to consultation, with 23 being diagnosed with chronic spontaneous urticaria, 8 with inducible urticaria and 3 with both entities. Older age (p < 0.001), personal history of atopy (p = 0.019) and angioedema (p = 0.003) were factors associated with CU, while the presence of other accompanying symptoms (p = 0.007) was associated with AU. Older age (OR = 1.2; p < 0.001) and the presence of angioedema (OR = 2.7; p = 0.007) were identified as independent factors for CU.

Conclusion: The majority of episodes corresponded to AU. Infections were the main suspected trigger, followed by drugs and food, with an overall confirmation rate ranging from 18 to 30%, highlighting the importance of an allergologic follow-up evaluation.

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