ACUTE URTICARIA IN INFANCY AND EARLY-CHILDHOOD - A PROSPECTIVE-STUDY

Objectives: To establish the clinical, etiological, and prognostic fea tures of acute urticaria in infancy and early childhood and to define its optimal management. Design: Prospective study. The inception cohor t was collected from April 1, 1992, through March 31, 1994. After init ial evaluation, the course of the disease was assessed at 2 months and after 1 to 2 years. Setting: Emergency department of a regional teach ing pediatric hospital (referral center), which is also the only pedia tric hospital for the general community in the city (population, 60000 0 inhabitants). Patients: Fifty-seven consecutive infants, aged 1 to 3 6 months, hospitalized with a final diagnosis of acute urticaria. Foll ow-up at 1 to 2 years was available in 40 of 57 patients. Intervention : Oral antihistamines (dexchlorpheniramine maleate, terfenadine, or hy droxyzine hydrochloride) for 2 weeks. Main Outcome Measures: Recurrenc e and chronicity. Results: Annular or geographic papules and plaques w ith hemorrhagic lesions were seen in 28 patients (49% of cases) and an gioedema in 34 patients (60% of cases). An underlying cause was suspec ted or identified in 52 patients (91% of cases). Infection, either ass ociated or not with drug intake, was the cause in 46 patients (81%) an d foods were the cause in 6 (11%). Parasitic infestations were noncont ributory. Hemorrhagic lesions and association with articular symptoms were statistically more frequent in urticaria caused by infections. At opy in the patient or family was associated in 33 patients (58% of cas es), and particularly atopic dermatitis was associated with urticaria caused by food. At 1- to 2-year follow-up, 12 (30%) of 40 patients sur veyed had chronic or recurrent urticaria. Conclusions: Causative facto rs in urticaria are dominated by benign viral illnesses, often associa ted with antibiotic drug therapy. In most patients, laboratory investi gations are not required. Twenty percent to 30% of cases evolve into c hronic or recurrent disease.