Background: Chronic urticaria (CU), daily wheals or angioedema that lasts more than 6 weeks, is a common skin disease; CU is classified as spontaneous (no specific eliciting factor involved) or inducible (specific eliciting factor involved). Recent EAACI guidelines for management of CSU recommend second-generation non-sedating H1 antihistamines (sgAH(1)s) as initial treatment in children (weight-adjusted) as in adults, followed by increased doses (up to 4 times) if the standard dose is not effective. The efficacy and tolerability of fourfold updosing in adults are known, but there is little documentation regarding updosing in the pediatric population. This retrospective study evaluates the efficacy and tolerability of the updosing of sgAH(1)s in children with CSU in a tertiary care pediatric hospital.Methods: The electronic charts of patients diagnosed with CSU and referred to the Allergy Unit of Meyer Children's University hospital were reviewed during a period of 4 years. For each patient, an examination of demographic characteristics, diagnostic workup, efficacy, and tolerability of the treatment was performed. Disease activity was monitored using UAS7.Results: Sixty-six cases of CSU were identified, and all of them were treated initially with a standard dose of sgAH(1)s, followed by increased doses up to fourfold when standard dosing was not effective. 44/66 patients (66.7%) treated with sgAH(1)s responded: 25 with a standard dose, 16 with a double, 2 with threefold dose, and 1 with fourfold dose. 12/66 (18.2%) patients began a therapy with omalizumab. As for the remaining patients, 10/66 (15.1%), they are still undergoing therapy with sgAH(1)s because of the relapse of the symptoms after the stepped-down dosage. Regarding tolerability, 9/66 (13.6%) patients treated with sgAH(1)s experienced side effects: three that required treatment change and six that did not.Conclusion: Our data were consistent with the tolerability of updosing of sgAH(1)s in children with CSU, although the efficacy appears to be limited to double the standard dose.

Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria / Sarti, Lucrezia; Barni, Simona; Giovannini, Mattia; Liccioli, Giulia; Novembre, Elio; Mori, Francesca. - In: PEDIATRIC ALLERGY AND IMMUNOLOGY. - ISSN 0905-6157. - ELETTRONICO. - 32:(2021), pp. 153-160. [10.1111/pai.13325]

Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria

Sarti, Lucrezia;Barni, Simona;Giovannini, Mattia;Liccioli, Giulia;Novembre, Elio;Mori, Francesca
2021

Abstract

Background: Chronic urticaria (CU), daily wheals or angioedema that lasts more than 6 weeks, is a common skin disease; CU is classified as spontaneous (no specific eliciting factor involved) or inducible (specific eliciting factor involved). Recent EAACI guidelines for management of CSU recommend second-generation non-sedating H1 antihistamines (sgAH(1)s) as initial treatment in children (weight-adjusted) as in adults, followed by increased doses (up to 4 times) if the standard dose is not effective. The efficacy and tolerability of fourfold updosing in adults are known, but there is little documentation regarding updosing in the pediatric population. This retrospective study evaluates the efficacy and tolerability of the updosing of sgAH(1)s in children with CSU in a tertiary care pediatric hospital.Methods: The electronic charts of patients diagnosed with CSU and referred to the Allergy Unit of Meyer Children's University hospital were reviewed during a period of 4 years. For each patient, an examination of demographic characteristics, diagnostic workup, efficacy, and tolerability of the treatment was performed. Disease activity was monitored using UAS7.Results: Sixty-six cases of CSU were identified, and all of them were treated initially with a standard dose of sgAH(1)s, followed by increased doses up to fourfold when standard dosing was not effective. 44/66 patients (66.7%) treated with sgAH(1)s responded: 25 with a standard dose, 16 with a double, 2 with threefold dose, and 1 with fourfold dose. 12/66 (18.2%) patients began a therapy with omalizumab. As for the remaining patients, 10/66 (15.1%), they are still undergoing therapy with sgAH(1)s because of the relapse of the symptoms after the stepped-down dosage. Regarding tolerability, 9/66 (13.6%) patients treated with sgAH(1)s experienced side effects: three that required treatment change and six that did not.Conclusion: Our data were consistent with the tolerability of updosing of sgAH(1)s in children with CSU, although the efficacy appears to be limited to double the standard dose.
2021
32
153
160
Sarti, Lucrezia; Barni, Simona; Giovannini, Mattia; Liccioli, Giulia; Novembre, Elio; Mori, Francesca
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1308282
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