An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI Task Force report

Background: The EAACI Task Force entitled “Improving Chronic Urticaria (CU) Management in Pediatrics” aimed to explore the differences in the diagnostic and management practices for CU in children (0–18 years). Methods: An online clinical survey including 41 multiple choice questions on current practices for the management of childhood CU was disseminated among EAACI members. Results: The survey was circulated to 50,472 contacts via mass email and to 2343 contacts via EAACI social media channels and answered by 161 participants from 55 countries. Most respondents were pediatric allergists (74.5%). While 68.3% of the respondents stated that they use the EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline, 10.6% declared that they do not use any guideline. Full blood count (83.3%), thyroid profile (64.6%), IgE (62.7%), thyroid antibodies (62.1%), C-reactive protein (59%), and antinuclear antibodies (ANA) or other antibodies (50.9%) were the most commonly used routine tests when diagnosing CU patients. Less than 20% of the respondents said they test their patients routinely for chronic induced urticaria when clinically suspected. Reasons for not testing at all were a lack of needed equipment or not knowing how to perform the test. In patients who do not respond to second-generation antihistamine standard dose, two to four-times increased dosage was the preferred step, independently of the child's age. Many participants do not prescribe omalizumab in children aged <5 years (77.6%), 6–11 years (45%), and adolescents (24.7%). In children who do not respond to omalizumab, almost half of the prescribing clinicians stated that they prefer oral ciclosporin-A, and 20% use oral corticosteroids. Conclusions: Some challenges to the effective use of evidence-based CU guidelines persist around basic testing in the diagnostic workup and pharmacological treatment in children. This study suggests the need for broader availability of specific testing tools and for further education and research in this field.