Management

With limited data available for the management of CSU in children, most management and treatment recommendations are based on an extrapolation of adult data.

It is strongly recommended that first-generation H1-antihistamines are not prescribed to infants and children with urticaria (Zuberbier et al., 2018)


The initial step in managing paediatric urticaria is the identification of triggers, where possible, and their subsequent avoidance (Marrouche and Grattan, 2012). However, for many patients with urticaria, especially CSU, this is not possible. Pharmacological treatment remains symptomatic and paediatric patients over 6 months of age should initially be treated with second-generation H1-antihistamines (Zuberbier et al., 2018). These treatments have been shown to be very effective in a population of children with CSU (N=98; age = 0.5–16 years) with 50% achieving symptom control with licensed doses of second-generation H1-antihistamines (Figure 5). Furthermore, up to 96.9% of patients had controlled CSU symptoms when antihistamine doses were increased between 2 and 4 times the licensed dose (Lee et al., 2016).

Figure 5: Percentage of patients achieving symptom control with licensed and increased doses of second-generation H1-antihistamines.

Figure 5: Percentage of patients achieving symptom control with licensed and increased doses of second-generation H1-antihistamines (Lee et al., 2016).