The Common Triggers of Urticaria in Children Admitted to The Pediatric Emergency Room

To evaluate the most common triggers of urticaria in pediatric patients presenting to the emergency department.

This study included patients ages 0 to 18 who presented to Haceteppe University Pediatric Emergency Department from January 1, 2013 to December 31, 2013 and were documented to have urticaria with the International Classification of Diseases-10th Edition code, L50.

The retrospective component of this study included chart review of patient demographics, medical history, physical exam, laboratory results, and treatments. An acute episode of urticaria was identified as lasting less than 6 weeks, whereas a chronic episode was longer than 6 weeks. Severity of urticaria was assessed by the number of wheals. Triggers for urticaria were identified as infections, drugs, food, insect bites, blood products, and vaccines. When there was suspicion for an allergic reaction, phone interviews were conducted. The prospective component involved patient evaluation by pediatric allergists, specific IgE levels, skin tests, and oral challenges. Statistical analyses were performed, yielding results as odds ratios with a 95% confidence interval and a P value < .05.

Of 842 patients documented with urticaria, 462 patients were confirmed to have urticaria based on retrospective review. Cases classified as acute urticarial totaled 407 and 55 cases as chronic urticaria. Forty six percent of the cohort had an identified trigger. Common triggers included infection (18%), drugs (11%), food (8%), and insect bites (3%). Upper respiratory tract infections made up the largest portion of infection-related triggers of urticaria (74.5%). Infection-related urticaria was significantly associated with children under the age of 6 (P = .048). Drugs that were commonly associated with urticaria included β-lactam antibiotics (57%) and nonsteroidal anti-inflammatory drugs (12.7%). Foods associated with urticaria were cow’s milk (32.4%), nuts (24.3%), and eggs (18.9%). Food-related urticaria was significantly associated with children under the age of 6 (P < .001). Six percent of the cohort was diagnosed with IgE-mediated allergic disease. Urticaria severity was higher in patients readmitted to the emergency department (P < .001) and was the most predictive factor for recurrent referrals to the emergency department (P < .001).

This study demonstrates that infections, particularly upper respiratory infections, are the most common trigger of urticaria in pediatric patients presenting to the emergency department. Drug and food allergies are common causes of allergic-mediated urticaria. The severity of urticaria may be associated with readmission rates.

Urticaria is a frequent chief complaint in the pediatric emergency department, and thus, identifying its cause is important in preventing progression and recurrence. This study highlights the role of infection as a major source of urticaria, in addition to drug and food exposures, which allows clinicians to avoid extensive evaluations in the outpatient setting.