Urticaria is a common disease and is one of the most common cause of emergency unit visit in children. However, there is no standardized management about acute urticaria and few articles report about urticaria in infants and children. The aim of this study was to define the clinical features, causes, and current status of treatment in infants and children in emergency department.
Methods
We retrospectively reviewed all children aged less than 18years who visited emergency department for acute urticaria or angioedema at Seoul national university hospital, Seoul, Korea, from July 1, 2014 through December 31, 2014. The diagnosis of urticaria and angioedema was made on clinical grounds. The review included a history based on a standardized questionnaires such as precipitating events (eg, food intake, drugs, insect bites or other factors), complete physical examination, further evaluations trying to find the etiology (skin-prick test, serum-specific IgE or multiple allergen stimulation tests) and treatment performed in emergency unit.
Results
212 consecutive infants, aged less than 18years, visited emergency department with a final diagnosis of acute urticaria (195 patients, 91.9%) and angioedema (17 patients, 8.01%). The causative event was identified in 112 patients (52.8%), the rest of patients are unidentified. Associated with foods were identified in 84 patients (39.6%), drug intake in 17 patients (8.0%) and others causes in 11 patients (5.1%). The other causes were vaccination, contact with a dog, insect bite or grass exposure. All patients were treated with oral anti-histamine. Anti-histamine injection was given in 134 patients (63.2%), systemic steroid in 25 patients (11.8%) and bronchodilator in 5 patients (2.3%). All the patients but one has discharged with oral anti-histamine, one children was hospitalized suspected of Stevens-Johnson Syndrome. The allergy test was performed in 19 patients (8.9%) at outpatient clinic and 16 patients (7.5%) showed positive results.
Conclusions
Causative factors in urticaria are identified in 52.8% and the allergy test are preformed in 8.9% of the patients who visited emergency department with urticaria or angioedema. The causes are dominated by foods, drugs and other causes, in order. Routine treatment included oral anti-histamine therapy and anti-histamine injection, systemic steroid or bronchodilator were added according to the clinical characteristics. The outcome was quiet good.