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Common Triggers of Urticaria in Children
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The medical records of 462 children who visited the pediatric emergency department (PED) for urticaria were reviewed, and follow-up phone calls and diagnostic tests were performed to elucidate the cause of urticaria. A trigger for urticaria was suspected in 46% of patients who visited the PED based on history and physical examination. The most common triggers were infections, drugs, foods, infections and drugs, insects, pollen, blood products, and vaccines. Further diagnostics tests for allergic diseases confirmed food allergy in 2.4%, drug allergy in 1.7%, and venom allergy in 0.2% patients. Readmissions were common.
- The most common identifiable triggers for urticaria in children presenting to the PED were infections and drugs. IgE-mediated allergies were triggers in a small percentage of patients.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Urticaria frequently causes pediatric emergency department (PED) admissions. Children with urticaria may unnecessarily avoid suspected allergens. We aimed to investigate the possible and exact triggers of urticaria in children admitted to the PED.
METHODS
Medical records of children admitted to the PED within a 1-year period were evaluated for the International Classification of Diseases 10 (ICD-10) L50 urticaria code, noting symptoms, and possible triggers of urticaria. We performed telephone interviews to complete the missing data and further diagnostic tests for IgE-mediated allergies to identify the exact triggers of urticaria.
RESULTS
Among 60,142 children, 462 (0.8%) with the L50 code were evaluated. Possible triggers based on the history and physical examination could be identified in 46%: infections (18%), drugs (11%), foods (8%), infections and drugs (3%), insects (3%), pollen (1%), blood products (0.4%), and vaccines (0.4%). The most frequent infections related to urticaria were upper respiratory tract infections (74.5%), urinary tract infections (13.2%), gastroenteritis (8.2%), and otitis media (4.1%). After a diagnostic workup, IgE-mediated allergic diseases were diagnosed in 6% of patients. Twenty-two percent of the patients had multiple PED admission for the same urticaria flare. Urticaria severity was found to be the most important risk factor for readmissions to the PED (odds ratio: 3.86; 95% confidence interval: 2.39-6.23; p < .001). No relationship between urticaria severity, duration, and the triggers was present.
CONCLUSIONS
Despite detailed diagnostic tests, IgE-mediated allergic triggers were rarely the cause of urticaria in children admitted to the PED. Infections are the most frequent trigger. Severe urticaria causes more frequent readmissions to the PED.
Additional Info
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The common triggers of urticaria in children admitted to the pediatric emergency room
Pediatr Dermatol 2022 May 06;[EPub Ahead of Print], H Bezirganoglu, E Arik Yilmaz, UM Sahiner, O Soyer, BE Sekerel, O Teksam, B Buyuktiryaki, C SackesenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Acute urticaria is extremely common in children and is a common presenting complaint to a pediatric emergency department (ED). Most often acute urticaria is triggered by infection in children, but many parents worry about allergic triggers such as an allergenic food. An etiology for chronic urticaria is less commonly identified. In keeping with this, these authors report triggers for urticaria in a study of 462 patients seen in a pediatric ED. The most common identified acute triggers included infectious causes, primarily upper respiratory tract infections, followed by beta-lactam antibiotics. Identified triggers were less common in chronic urticaria patients.
Most patients that present to the ED for urticaria had mild or moderate clinical findings and many returned to the ED during the same episode. While this study aimed to identify triggers for urticaria, it highlights the misuse of emergency services for a common childhood complaint. One that can be evaluated and managed by both dermatologists and primary care providers.