Urticaria and angioedema

Abstract

Urticaria is a very common skin disorder in children. It is characterized by the sudden onset of hives (oedematous central papule, very itchy, surrounded by erythema, which whitens on vitro pressure and measures from millimetres to several centimetres), angioedema (oedematous involvement of the deeper layers of the skin or mucosa), or both at the same time. Many pathologies of diverse etiopathogenesis are expressed in the form of hives, since all ultimately share the degranulation of the cutaneous mast cell. To make the diagnosis, a detailed medical history and physical exam shall be enough. Depending on how often hives appear, urticaria will be classified as acute or chronic. We refer to acute urticaria (with/without angioedema) when episodes last less than six weeks. If it is longer, it will be considered chronic. When urticaria is acute but repetitive, it should be considered a chronic urticaria. The most common cause of acute urticaria in children is infection and laboratory tests will not be necessary most of the times. Other causes include food allergies, drug reactions, or insect bites. Physical and autoimmune urticaria are chronic. Second-generation antihistamines are the first line therapy option. In the case of severe urticaria or non-responsive patients, corticosteroids are the second choice. If systemic involvement is associated, adrenaline should be administered intramuscularly.