Urticaria in children
The content of the article:
- Causes of urticaria in children and risk factors for its development
- Forms of the disease
- Symptoms of urticaria in children
- Diagnostics
- Treatment of urticaria in children
- Possible complications and consequences
- Forecast
- Prevention
Urticaria in children is a skin disease of acute or chronic course, manifested by the appearance on the skin of a characteristic urticarial rash, represented by blisters, similar in appearance to a nettle burn.
Urticaria properties characteristic urticaria rash
The prevalence of urticaria in the adult population, according to various sources, reaches 20-25% (at least 1 episode in a lifetime), about a quarter of cases of acute urticaria are transformed into a chronic form. In about half of patients, the disease is accompanied by angioedema (angioedema). In the structure of allergic pathology, urticaria and Quincke's edema rank second in morbidity after bronchial asthma.
In recent years, in pediatric practice, the number of requests for this disease has significantly increased. According to recent studies, the incidence of urticaria in children ranges from 2-7%, most have a burdened hereditary allergic anamnesis, half have concomitant allergic diseases. Most often, the disease is recorded in girls aged 1 to 6 years. As they grow older, on average, in 6 out of 10 children, urticaria symptoms spontaneously stop, otherwise relapses occur at an older age, the disease may become chronic.
The intensity of inflammatory changes in the skin with urticaria in children directly depends on the age group. It was found that at the age from birth to 2 years, urticaria in children, as a rule, is acute, while at the age of up to six months it is practically not recorded. From 2 years to 12, the course of the disease is also predominantly acute or chronic with a predominance of acute forms, urticaria in children over 12 years of age is mainly chronic.
At the age of 3 years, the disease can be urgent, which requires compulsory hospitalization in a specialized department of the hospital.
Causes of urticaria in children and risk factors for its development
The central element in the pathogenesis of urticaria is the destabilization of mast cells. Immunological and non-immune provocateurs (both different chemicals and physical factors) can act as mast cell activators.
Mast cells, or mast cells, are highly specific connective tissue cells containing granules with biologically active substances, inflammatory mediators: histamine, leukotrienes, prostaglandins, platelet activation factor, etc., as well as carrying specialized receptors for immunoglobulin E on their surface. Mast cells play one of the defining roles in the development of immediate allergic reactions.
When mast cells are activated, a massive release of the mediators contained in them into the blood occurs, which leads to a whole cascade of pathological changes in the body:
- bronchospasm;
- increased permeability of the vascular walls;
- swelling of mucous membranes, skin microstructures;
- increased mucus production by the glandular cells of the bronchial tree;
- spastic contractions of smooth muscle tissue of the gastrointestinal tract;
- decreased tone of the vascular bed;
- gluing platelets;
- skin rashes.
The causes of urticaria in children can be roughly divided into two main groups: allergic and non-allergic.
Causes of allergic urticaria in children:
- the use of highly allergenic foods, additives (nuts, red fruits and vegetables, citrus fruits, honey, etc., as well as preservatives in food, dyes, stabilizers, etc.), at the age of up to 2 years, this cause provokes up to ¾ of the total episodes of acute urticaria;
- Hymenoptera bites;
- taking medications (for example, penicillin antibiotics, sulfonamides, acetylsalicylic acid, etc.);
- transfusion of blood and its components;
- the influence of infectious agents (bacterial, viral, fungal pathology, parasitic infections) in children over 2 years old causes 50% of cases of the disease;
- inhalation of pollen, house dust, some aerosols and vapors;
- vaccination;
- X-ray examination using a contrast agent.
Hives in a child may be due to the action of allergens
Causes of non-allergic urticaria in children:
- exposure to low temperatures, ultraviolet radiation, vibration;
- contact with water;
- prolonged compression of soft tissues;
- excessive physical or psycho-emotional stress.
In addition to the manifestation of urticaria in children as an independent disease, in some cases it can be one of the symptoms of the underlying pathology:
- viral, bacterial, fungal and parasitic infections;
- diseases of the endocrine system (diabetes mellitus, hypo- or hyperfunction of the thyroid gland, etc.);
- a number of gastrointestinal diseases;
- skin diseases (erythema multiforme, bullous pemphigoid, dermatitis herpetiformis);
- diencephalic syndrome;
- immunocomplex diseases (serum, systemic lupus erythematosus, urticarial vasculitis);
- dysproteinemia;
- malignant neoplasms.
Risk factors for developing urticaria in children:
- the presence of allergic diseases;
- episodes of urticaria in the past (even one-off);
- burdened hereditary allergic anamnesis;
- severe concomitant chronic diseases.
Chronic urticaria in children, in contrast to acute, in most cases is non-allergic, it is not possible to identify immune mechanisms in the bulk of patients.
A characteristic feature revealed in the course of the research is information on artificial feeding during the neonatal period in most children with urticaria.
Forms of the disease
Depending on the duration, urticaria in children is classified as follows:
- acute (active symptoms persist for less than 6 weeks);
- chronic (lasting more than 6 weeks, undulating course with episodes of exacerbations and remissions).
According to the etiological factor:
- allergic, or immune-mediated urticaria in children - based on immunological mechanisms of activation of mediators of allergic inflammation (including IgE-mediated, immunocomplex, autoimmune);
- pseudo- or non-allergic - provoked by the same biologically active substances, but without the participation of immune factors;
- mixed;
- idiopathic - of unknown origin, accounts for up to 25% of all cases of the disease.
Forms of non-allergic urticaria in children:
- cold (acquired and familial, primary and secondary, immediate and delayed, localized and systemic);
- thermal;
- pressure urticaria (immediate or delayed);
- solar;
- vibration;
- dermographic (primary and secondary, follicular, red, white and cold-dependent dermographism);
- aquagenic (provoked by exposure to water);
- cholinergic (in response to an increase in body temperature or emotional overload);
- contact;
- physical effort.
Symptoms of urticaria in children
Signs of urticaria in children may vary depending on the form of the disease, however, the main manifestations in most cases are similar:
- characteristic urticarial rashes (rounded, noncavity elements rising above the skin level with a diameter of several millimeters to several centimeters, red-pink color of varying degrees of saturation, in some cases prone to fusion; after the blister disappears, no visible changes remain on the skin);
- intense, excruciating itching where the rash appears;
- angioneurotic edema of various localization (in half of cases).
With urticaria in children, characteristic rashes appear on the body, accompanied by severe itching
Features of cold urticaria in children:
- long course (persistence for 5-10 years);
- frequent manifestation against the background of previous infectious diseases;
- the appearance of rashes in the first minutes after exposure to low temperatures or immediately after rewarming (the disappearance of blisters within half an hour to an hour);
- local edema of the soft tissues of the mouth and pharynx after eating cold food.
Characteristic features of dermographic urticaria:
- rashes along the course of scratching or in the place of stroking;
- the most common localization is the face, upper limbs, upper half of the body;
- the duration of the disease usually does not exceed 2-3 years.
The specificity of urticaria, provoked by pressure, is painful, pronounced swelling of soft tissues at the site of exposure to causative factors, which in some cases is accompanied by intense symptoms of intoxication. Favorite places of localization of rashes: palmar surface of the hands, plantar surface of the feet, buttocks, shoulders.
Cholinergic urticaria is characterized by the following manifestations:
- provocateurs in the form of physical and emotional overstrain, exposure to extreme temperatures, excessive sweating;
- age over 10 years;
- rashes appear within 10-30 minutes after an increase in body temperature (physical activity, stress, a warm bath, etc.), are small (several millimeters), surrounded by a zone of intense hyperemia, tend to merge;
- rapid cooling of the skin in some cases contributes to the disappearance of rashes.
Other forms of urticaria in children are extremely rare.
Diagnostics
Diagnosis of urticaria in children is based on the assessment of the following indicators:
- characteristic clinical picture;
- connection with previous exposure to an allergen or an adverse factor in the external or internal environment;
- general blood test (signs of allergic inflammation);
- results of allergological tests (identification of sensitization to certain antigens, determination of the level of immunoglobulin E).
In children under 3 years of age, specific tests are not recommended, since due to imperfect functioning of the immune system, the percentage of the likelihood of false positive and false negative results is high.
In order to find out the cause of the urticaria, it is recommended to conduct allergy tests
To confirm the diagnosis in case of suspicion of physical urticaria, provocative tests are carried out:
- streak skin irritation with a flat object (dermographic urticaria);
- test with dosed physical activity, local heat (cholinergic urticaria);
- ice cube test (cold);
- phototesting (solar);
- sample with hanging weight (urticaria due to pressure);
- applying a water compress at room temperature (aquagenic urticaria).
Treatment of urticaria in children
In 2001, uniform international criteria were developed for the treatment of acute and chronic forms of the disease, including in children:
- avoidance of provoking factors in the case of the immunological nature of the disease (hypoallergenic environment, refusal of food products that stimulate the production of histamine, careful approach to the choice of drugs, etc.);
- taking antihistamines, preferably the 2nd and 3rd generations (the duration of the course in the acute period is usually 7-14 days, in the chronic process - from several months to a year or more, with recurrence of urticaria in children against the background of drug withdrawal, pharmacotherapy is resumed);
- hormonal therapy with insufficient effectiveness of antihistamines (glucocorticosteroids);
- in the case of an infectious nature of the disease - taking antimicrobial, antiparasitic, antifungal or antibacterial drugs;
- with a clear connection between the development of urticaria in children with food allergies - elimination diet, intake of adsorbents;
- immunotherapy as needed.
With the immune mechanism of the development of the disease, adherence to a special diet for urticaria in children is shown:
- exclusion from the diet of foods that stimulate the release of histamine (histaminoliberators), which include chocolate, citrus fruits, red and orange vegetables and fruits, eggs, etc.
- exclusion of products containing chemical additives (preservatives, stabilizers, dyes, thickeners, etc.);
- a sufficient amount of water, refusal to packaged drinks and purees;
- exclusion from the diet of carbonated sweet drinks.
With urticaria, the child is shown a hypoallergenic diet
The effect of a hypoallergenic diet in children with urticaria is noted no earlier than one and a half to two weeks, the duration of the diet is 3 months or more (depending on the clinical manifestations of the disease).
Possible complications and consequences
Complications of urticaria in children can be:
- violation of the patency of the upper respiratory tract (including angioedema of the larynx);
- generalization of the process (spread of urticaria over the entire surface of the body);
- dyspeptic disorders.
Forecast
Spontaneous relief of urticaria symptoms in children occurs in 50% of cases within 6 months from the onset of the first painful manifestations, within 3 years - in 20% of patients, in another 20% - after 5 years from the onset of the disease.
More than half of the children subsequently experience at least one relapse of the disease.
Prevention
Main preventive measures:
- preventive appointment of antihistamines;
- avoiding contact with allergens;
- creating a hypoallergenic environment in everyday life.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
