The natural history of chronic urticaria in childhood: A prospective study

Background: There are few prospective studies on the natural course of chronic urticaria (CU) in children. Objective: We sought to examine the natural history of CU in children and to identify predictors for remission. Methods: Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication. Results: In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5 years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified. Limitations: The basophil histamine release assay was not performed. Conclusion: Children with CU have a favorable outcome. CAU did not have an intractable course. ( J Am Acad Dermatol 2014;71:663-8.).