In children, chronic urticaria is not a common disorder but it can present with significant morbidity. Also, it can increase frustration for the parents and healthcare provider. The incidence is 0.1-0.3% but can vary greatly country-wise.

Chronic urticaria has a significant impact on quality of life and on healthcare expenses too. An adverse effect is more predominant affecting the quality of life in older children and adolescents as compared to other childhood diseases such as diabetes and epilepsy.

Healthcare expenses can be higher by 50% than the national estimates for healthy patients. This includes increase in hospitalizations, duration of hospitalizations, and more emergency and outpatient visits. Allergic and autoimmune diseases can become comorbidities adding to healthcare utilization. Recommendations are available for their diagnosis and treatment. A proper history taking is the most important factor in identifying the cause. Minimal laboratory investigations should be required and guided by the history of the patient. Patients with easily controlled urticaria might not require any laboratory investigation.

The treatment suggested highlights the use of non-sedating antihistamines and to be utilized in a step-wise approach, starting with normal doses and then advancing the dose based on the response up to four times the recommended dose for the given age. The recommended guidelines are not utilized properly in the real-world setting. Oral steroids and sedating antihistamines are over utilized. Medications are to be taken daily and not as required. Extra medications, if required, should be included to prior medications in a step-wise manner. The gap between the recommendations for diagnosis and treatment and what is being followed in the real world should be sealed to reduce the cost and morbidity associated with chronic urticaria.

Source: Williams PV. Pharmacologic Management of Chronic Urticaria in Pediatric Patients: The Gap Between Guidelines and Practice. Paediatr Drugs. 2020 Feb; 22(1):21-28