Early severity of hives may signal chronicity

By Agata Buczak

Research suggests that children exhibiting more severe symptoms during the first week of an acute urticaria (AU) episode may be at increased risk of developing chronic spontaneous urticaria (CSU).

“These findings may help to develop strategies to effectively manage AU in the early stages,” write Güler Yıldırım (Cemil Taşçıoğlu City Hospital, Istanbul, Turkiye) and co-researchers in Pediatric Allergy and Immunology.

The study followed 155 children with a median age of 5 years and found that 9% progressed from AU to CSU. Notably, higher Urticaria Activity Scores in the first week (UAS7) were significantly associated with this progression; each unit increase in UAS7 corresponded to a 16.9% increase in the odds of developing CSU.

Furthermore, children requiring more intensive treatment, such as corticosteroids, multiple antihistamines, antibiotics, or leukotriene receptor antagonists, had over eight times the odds of progressing to CSU compared with those who received standard antihistamines alone.

The authors suggest that this association between additional therapies and progression to chronic urticaria may reflect the potential inclusion of refractory or more complex cases.

Elevated eosinophil levels were observed in children who developed CSU; however, they were not confirmed as an independent predictor in multivariate analysis, suggesting that eosinophils alone are not sufficient.

The researchers state that their study differs from previous work by prospectively following children with AU to monitor progression to chronic urticaria, rather than relying on retrospective data or adult populations.

The authors conclude that their prospective follow-up of children from diagnosis enabled them to identify severity in the first week and the need for additional therapies as important indicators for the risk of progression.

That said, Yıldırım et al. caution the single-center design and relatively short follow-up period, and they recommend conducting larger, multicenter studies with longer follow-up to validate these findings. They also suggest that assessing a broader range of immunologic parameters in future research may help to better understand the factors involved in disease progression.

Developed by EPG Health, for Medthority. The article has been developed independently of any sponsor.