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

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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


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


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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1. Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022; 77(3):734–766. 10.1111/all.15090

2. Schaefer P. Acute and chronic urticaria: evaluation and treatment. Am Fam Physician. 2017;95(11):717–724.

3. Guo C, Saltoun C. Urticaria and angioedema. Allergy Asthma Proc. 2019;40(6):437–440. 10.2500/aap.2019.40.4266

4. Pier J, Bingemann TA. Urticaria, angioedema, and anaphylaxis. Pediatr Rev. 2020;41(6):283–292. 10.1542/pir.2019-0056

5. Kanani A, Betschel SD, Warrington R. Urticaria and angioedema. Allergy Asthma Clin Immunol. 2018;14(Suppl 2): 59. 10.1186/s13223-018-0288-z

6. Caffarelli C, Duse M, Martelli A, Calvani M, Cardinale F, Chiappini E, et al. Urticaria in childhood. Acta Biomed. 2020;91(11-S):e2020013.

7. Rios M, Silva R, Cunha L, Gomes E, Falcão H. Urticária crónica numa população pediátrica. Nascer Crescer. 2012;XXI:80–85.

8. Talarico V, Marseglia GL, Lanari M, Esposito S, Masi S, De Filippo M, et al. Pediatric urticaria in the emergency department: epidemiological characteristics and predictive factors for its persistence in children. Eur Ann Allergy Clin Immunol. 2021;53(2):80–85. 10.23822/EurAnnACI.1764-1489.148

9. Techasatian L, Phungoen P, Chaiyarit J, Uppala R. Etiological and predictive factors of pediatric urticaria in an emergency context. BMC Pediatr. 2021;21(1):92. 10.1186/s12887-021-02553-y

10. Santa C, Valente CL, Mesquita M, Lopes J, Cardoso I, Barreira P, et al. Acute urticaria in children: from pediatric emergency department to allergology consultation at a central hospital. Eur Ann Allergy Clin Immunol. 2022;54(4):168–174. 10.23822/EurAnnACI.1764-1489.204

11. Marques-Mejias MA, Tomas-Perez M, Vila-Nadal G, Quirce S. Acute urticaria in the pediatric emergency department: management and possible triggers. Ann Allergy Asthma Immunol. 2020;124(4):396–397. 10.1016/j.anai.2020.01.007

12. Notejane M, Defaz V, Cantarán V, Dall’Orso P. Urticaria y anafilaxia en un Departamento de Emergencia Pediátrica de referencia em Urugay: estudio clínico y epidemiológico. Arch Pediatr Urug. 2018;89(5):311–319.

13. Chambel M, Antunes J, Prates S. O mundo da urticária, com e sem alergia. Rev Port Clínica Geral. 2010;27:1–11. 10.32385/rpmgf.v27i1.10824

14. Miles LM, Gabrielli S, Le M, Netchiporouk E, Baum S, Greenberger S, et al. Clinical characteristics, management, and natural history of chronic inducible urticaria in a pediatric cohort. Int Arch Allergy Immunol. 2021;182(8):757–764. 10.1159/000514757

15. Napolitano M, Megna M, Costa C, Balato N, Patruno C. Chronic inducible urticarias in children. J Allergy Clin Immunol Pract. 2018;6(4):1391–1393. 10.1016/j.jaip.2017.12.021

16. Fricke J, Avila G, Keller T, Weller K, Lau S, Maurer M, et al. Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy. 2020;75(2):423–432. 10.1111/all.14037

17. Balp MM, Weller K, Carboni V, Chirilov A, Papavassilis C, Severin T, et al. Prevalence and clinical characteristics of chronic spontaneous urticaria in pediatric patients. Pediatr Allergy Immunol. 2018;29(6):630–636. 10.1111/pai.12910

18. Sabroe RA. Acute urticaria. Immunol Allergy Clin North Am. 2014;34(1):11–21. 10.1016/j.iac.2013.07.010

19. Lee SJ, Ha EK, Jee HM, Lee KS, Lee SW, Kim MA, et al. Prevalence and risk factors of urticaria with a focus on chronic urticaria in children. Allergy Asthma Immunol Res. 2017; 9(3):212–219. 10.4168/aair.2017.9.3.212

20. Minasi D, Manti S, Chiera F, Licari A, Marseglia GL. Acute urticaria in the infant. Pediatr Allergy Immunol. 2020;31(Suppl 26): 49–51. 10.1111/pai.13350

21. Cetinkaya PG, Soyer O, Esenboga S, Sahiner UM, Teksam O, Sekerel BE. Predictive factors for progression to chronicity or recurrence after the first attack of acute urticaria in preschool-age children. Allergol Immunopathol (Madr). 2019;47(5): 484–490. 10.1016/j.aller.2018.12.010

22. Costa C, Goncalo M, GPEU – Português de Estudos de Urticária. [Letter to the editor. Urticaria in the emergency room: recommendations for diagnostic and therapeutic approach]. Acta Med Port. 2017;30(4):347–349.

23. Tsakok T, Du Toit G, Flohr C. Pediatric urticaria. Immunol Allergy Clin North Am. 2014;34(1):117–139. 10.1016/j.iac.2013.09.008

24. Guvenir H, Dibek Misirlioglu E, Vezir E, Toyran M, Ginis T, Civelek E, et al. Nonsteroidal anti-inflammatory drug hypersensitivity among children. Allergy Asthma Proc. 2015;36(5): 386–393. 10.2500/aap.2015.36.3858