Guideline-Based Management Limits Testing and Identifies Risk Factors for Chronic Urticaria in Children

Most children presenting with a first episode of acute urticaria (AU) recover with conservative, guideline-based management and require little diagnostic testing, according to a prospective cohort study published in Pediatric Allergy, Immunology, and Pulmonology. The findings also identified prolonged symptom duration and physical triggers as independent predictors of progression to chronic urticaria (CU).¹

The single-center study prospectively enrolled 210 children with first-episode AU (median age, 5.4 years; 54.8% male). Diagnostic evaluation, etiologic assessment, and treatment followed recommendations from the European Academy of Allergy and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI). Participants were followed for a median of 5 months.

Most Pediatric Acute Urticaria Cases Resolve Without Extensive Work-Up

A suspected trigger was identified in 63.3% of patients, while a confirmed etiology was established in 61% following evaluation. Infections accounted for most confirmed cases (55.2%), followed by physical stimuli (5.2%) and food (0.5%). No cases of drug-induced urticaria were confirmed.

Consistent with current guideline recommendations, 65.7% of children required no diagnostic testing, and 95.2% achieved complete remission with standard antihistamine therapy. During follow-up, only 4.8% of patients developed CU.

Multivariable logistic regression identified urticaria lasting longer than 7 days (odds ratio [OR], 14.1; 95% CI, 2.62-75.73; P = 0.002) and physical stimuli (OR, 22.8; 95% CI, 2.95-177.19; P = 0.003) as independent predictors of progression to CU. Age, atopic status, and baseline disease severity were not significantly associated with chronicity.

Study limitations include its single-center design, relatively small number of patients who progressed to CU, and a median follow-up of 5 months, which may limit generalizability.

"Guideline-based conservative management provides excellent outcomes with minimal testing. Prolonged duration and physical stimuli are key predictors for chronic progression, underscoring the importance of close follow-up in these patients," the authors wrote.¹

References

1. Özdemir GN, Karakurt LT, Besli E, Cavkaytar Ö, Arga M. Clinical follow-up, etiology, and predictors of progression to chronic urticaria in children with acute urticaria: a guideline-based study. Pediatr Allergy Immunol Pulmonol. Published online July 20, 2026. doi:10.1177/2151321X261470202.