Although chronic urticaria (CU) in children is associated with a low rate of resolution, the presence of certain biomarkers may help predict disease resolution, according to the findings of a recent study published in JAMA Dermatology.
A pediatric cohort with CU was followed between 2013 and 2015 at a single tertiary care center in Montreal, Canada. All patients presented with hives lasting ≥6 weeks. Data on disease activity, comorbidities, physical triggers, BAT results, complete blood count, thyroid-stimulating hormone levels, thyroid peroxidase antibodies, and C-reactive protein levels were collected from all participants. The investigators assessed the rate of disease resolution (ie, absence of hives for ≥1 year with no treatment), and its relation to clinical and laboratory parameters.
A total of 139 consecutive children younger than 18 with chronic uticaria were recruited for the study. The mean age at disease onset was 6.7±4.7 years. The most common type of CU observed in the patients was CSU (n=108). Overall, 31 individuals had inducible urticaria, which was most often cold-induced; 6 children had autoimmune disorders, including thyroiditis and type 1 diabetes.
Positive BAT results (CD63 levels >1.8%) were reported in 58% of participants. Patients with positive BAT results were 2 times as likely to have disease resolution after 1 year compared with patients with negative BAT results (hazard ratio [HR] 2.33; 95% CI, 1.08-5.05). The presence of basophils, on the other hand, decreased the probability of resolution (HR 0.40; 95% CI, 0.20-0.99). There was no association reported between CU and age. CU resolved in 43 patients, with a rate of disease resolution of 10.3% per year. CD63 levels >1.8% and the absence of basophils were both linked to earlier resolution.
“[The] results reveal a low rate of resolution of CU in children,” concluded the researchers. “Parameters associated with better prognosis included CD63 level higher than 1.8% and absence of basophils.”
Studies designed to elucidate the mechanisms involved in these associations are warranted in order to better comprehend the pathogenesis of CU and develop appropriate management strategies.
Netchiporouk E, Sasseville D, Moreau L, Habel Y, Rahme E, Ben-Shoshan M. Evaluating comorbidities, natural history, and predictors of early resolution in a cohort of children with chronic urticaria [published online September 27, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.3182