Source:Plumb J, Norlin C, Young PC. Exposures and outcomes of children with urticaria seen in a pediatric practice-based research network. A case-control study.
Arch Pediatr Adolesc Med.

To determine the clinical course, precipitants, and management of urticaria in general pediatric practice, these investigators evaluated children who presented to 9 practices in Utah during a 13-month period. Physicians recorded clinical data; personal or family history of atopy; history of exposure to medications in the preceding 14 days; insect sting or bite, or intake of specific foods (peanuts, nuts, shellfish, tomatoes, or strawberries) in the past 48 hours. They also recorded laboratory tests performed, the degree of certainty as to the etiology of urticaria, and the treatment advised. The next patient of the same gender and age seen by the physician served as the control. Parents of patients were subsequently contacted by telephone to determine the duration of urticaria, presence of associated symptoms, and medication use.

Fifty-two children (56% female, mean age 69 months [range 6 months–18 years]) with urticaria were enrolled by 14 pediatricians and 1 physician assistant; follow-up contact was made with 46 parents. The median duration of urticaria was 5 days (range 1–50 days); 72% of children had resolution within 10 days. Antibiotic use within 14 days of onset was reported for 17 (33%) children and 1 control (odds ratio [OR], 22.3; 95% confidence interval [CI], 2.8–176; P<.01). Fourteen (27%) subjects and 5 (11%) controls had gastrointestinal symptoms (vomiting or diarrhea) (OR, 3.1; 95% CI, 1.02–9.4; P=.04). No significant differences between cases and controls were observed with respect to history of fever, sore throat, upper respiratory tract symptoms, personal or family history of atopy, ingestion of specific foods, medication use other than antibiotics, or history of insect sting or bite. Laboratory studies were performed in 7 patients of which 4 were tested and were negative for infection with Group A, β-hemolytic streptococcus. A cause was suspected in 54% of patients, but no physician was 100% certain of the etiology. Antihistamines were recommended for 41 (79%) patients and prednisone for 3 patients. There was a high degree of compliance (93% took the medications as prescribed) and parents reported drowsiness in 30% of cases. The authors conclude that recent antibiotic use is common among children with urticaria but that the role of other factors, including food ingestion, insect sting or bite, or infection is questionable.

Urticaria and angioedema are related disorders that result from the release and subsequent effects of inflammatory mediators on the skin.1,2 Increased capillary permeability leads to fluid and protein leak that causes swelling, while vasodilation results in erythema.1,2 When these changes occur in the superficial dermis, the result is urticaria; involvement of the subcutaneous tissue produces angioedema. Urticaria and angioedema may be caused by immunologic and nonimmunologic mechanisms.1,2 

These authors sought to determine the typical duration of symptoms, and whether or not recent infection, exposure to medications, certain foods, or insect venom...

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