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.


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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.

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Reference

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