Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical aspects of chronic urticaria in children

소아 만성 두드러기의 임상 양상 및 경과

  • Kang, Hye Seon (Department of Pediatrics, College of Medicine, Soonchunhyang University) ;
  • Shin, Mee Yong (Department of Pediatrics, College of Medicine, Soonchunhyang University)
  • 강혜선 (순천향대학교 의과대학 소아과학교실) ;
  • 신미용 (순천향대학교 의과대학 소아과학교실)
  • Received : 2008.07.29
  • Accepted : 2008.11.02
  • Published : 2009.02.15
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Abstract

Purpose : Chronic urticaria is a disorder characterized by the appearance of wheals for more than 6 weeks; in most cases, the etiology is unknown. This study was aimed to discover the clinical aspects, the etiologic factors, and the course of chronic urticaria. Methods : 51 children who were diagnosed with chronic urticaria in the past 4 years, and who had had follow-ups more than 6 months after diagnosis in the pediatric department of Soonchunhyang University Hospital in Bucheon, were enrolled in the study. The laboratory findings, clinical aspects, and courses were retrospectively investigated by medical record review and telephone interview. Results : The median age of children with chronic urticaria was 4 years (8 months to 16 years) and the ratio of male to female was 1.4:1. Of the total, 39.2% of patients had a history of atopy. Angioedema occurred concurrently with urticaria in 11.8% of patients, and dermographism was seen in 41.2%. Results of thyroid function tests were normal and thyroid autoantibodies were absent in all cases. Regarding etiology, most cases (74.5%) were forms of idiopathic urticaria. Urticaria was induced by physical factors in 19.6% of patients. Open challenge tests revealed that 3 patients were allergic to food additives (glutamate 2, glutamate, and sulfite 1). In this study, most of the patients reported good response after medication of 1st- or 2nd-generation antihistamines alone. Follow-up at 6 months revealed that 70.6% of patients had experienced remission, and 84.8% of children who had follow-up at 1 year presented remission. Conclusion : Chronic urticaria in most patients was idiopathic. Remission occurred within 1 year of diagnosis, in most cases so chronic urticaria in children seems to have good prognosis.

목 적 : 만성 두드러기는 적어도 6주 이상 팽진이 지속되는 것으로 정의되며, 그 원인을 모르는 경우가 대부분이다. 본 연구에서는 소아에서의 만성 두드러기의 원인과 임상경과를 알아보고자 하였다. 방 법 : 최근 4년간 순천향대학교 부천 병원에서 치료받았던 만성 두드러기 환아 51명을 대상으로 의무기록 분석과 전화 추적을 통해 검사결과와 임상양상 및 경과를 조사하였다. 결 과 : 내원 시 연령은 중앙 나이가 4년(8개월-16세)이었고, 남아가 30명, 여아가 21명으로 남녀 비는 1.4:1이었다. 원인으로서는 원인이 밝혀지지 않은 경우가 38명(74.5%)으로 가장 많았으며, 물리적 두드러기가 10명(19.6%), 식품 첨가물이 원인인 경우가 3명(5.9%)이었다. 피부 묘기증이 22명(42.3%), 혈관부종이 6명(11.5%)에서 동반되었다. 검사실 소견상 33명 중 18명(54.5%)에서 H. pylori IgG 항체가 양성이었고, 이중 5명이 이에 대한 치료를 받았으며 모두 치료 후 호전을 보였으나 3명은 수개월 후 두드러기가 재발하였다. 36명 중 9명(25.0%)은 ANA가 양성이었다. 갑상선 자가 항체를 포함한 갑상선 검사는 모두 정상이었다. 식품 첨가물 유발 검사에서 양성을 보인 환아가 3명(글루타민산염 2명, 글루타민산염 & 아황산염 1명) 있었다. 내원 전 두드러기 지속기간은 평균 17주(6-40주)였다. 치료 후 6개월까지의 추적 관찰에서 51명 중 36명(70.6%)의 환아가 완해를 보였다. 내원 후 1년까지 46명 중 39명(84.8%)이 완해를 보였으며, 이들의 내원 후 완해까지의 기간은 평균 11주(1주-1년)였으며 총 지속기간은 24주(6주-2년)였다. 1년 이상 지속된 환아는 7명으로, 두드러기의 총 지속기간은 평균 1년 10개월(13개월 2주-3년 9개월) 이었다. 결 론 : 소아 만성 두드러기의 원인으로서는 특발성이 대부분이었고, 밝혀진 원인으로는 물리적 두드러기가 가장 많았다. 대부분에서 내원 1년 이내에 두드러기가 소실되어 소아 만성 두드러기의 예후는 양호함을 알 수 있었다. 본 대상 환자에서 H. pylori 항체 양성률과 ANA 양성률이 높게 나타나, 이들과 소아 만성 두드러기와의 관계를 규명하기 위해서는 이에 대한 추가적인 연구가 필요할 것으로 생각된다.

Keywords

References

  1. Nettis E, Pannofino A, D'Aprile C, Ferrannini A, Tursi A. Clinical and aetiological aspects in urticaria and angio-edema. Br J Dermatol 2003;148:501-6 https://doi.org/10.1046/j.1365-2133.2003.05169.x
  2. Cansin S, Bulent E, Fazil O, Can NK, Ayfer T, Gonul A. The etiology of different forms of urticaria in childhood. Pediatr Dermatol 2004;21:102-8 https://doi.org/10.1111/j.0736-8046.2004.21202.x
  3. Harris A, Twarog FJ, Geha RS. Chronic urticaria in childhood: natural course and etiology. Ann Allergy 1983;51:161- 5
  4. Volonakis M, Katsarou KA, Stratigos J. Etiologic factors in childhood chronic urticaria. Ann Allergy 1992;69:61-5
  5. Schocket AL. Chronic urticaria: pathophysiology and etiology, or the what and why. Allergy Asthma Proc 2006;27:90- 5
  6. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993;328:1599-604 https://doi.org/10.1056/NEJM199306033282204
  7. Tong LJ, Balakrishnan G, Kochan JP, Kint JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 1997;99:461-5 https://doi.org/10.1016/S0091-6749(97)70071-X
  8. Brunetti L, Francavilla R, Miniello VL, Platzer MH, Rizzi D, Lospalluti ML, et al. High prevalence of autoimmune urticaria in children with chronic urticaria. J Allergy Clin Immunol 2004;114:922-7 https://doi.org/10.1016/j.jaci.2004.07.042
  9. Boguniewicz M. Chronic urticaria in children. Allergy Asthma Proc 2005;26:13-7
  10. Levy Y, Segal N, Weintrob N, Danon YL. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child 2003;88:517-9 https://doi.org/10.1136/adc.88.6.517
  11. Martina MAK, Ruth AS. Chronic urticaria. Drugs 2004;64: 2515-36 https://doi.org/10.2165/00003495-200464220-00003
  12. Sampson HA, Allan S. Evaluation of food allergy. In: Leung DY, Sampson HA, Geha RS, Szefler SJ, editors. Pediatric allergy; principles and practice. St. Louis: Mosby, 2003:478- 87
  13. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984;74:26-33 https://doi.org/10.1016/0091-6749(84)90083-6
  14. Kelso JM, Sodhi N, Gosselin VA, Yunginger JW. Diagnostic performance characteristics of the standard Phadebas RAST, modified RAST, and pharmacia CAP system versus skin testing. Ann Allergy 1991;67:511-4
  15. Choi SY, Park HY, Ahn YM. Chronic urticaria in childhood: Etiology and outcome. Pediatr Allergy Respir Dis(Korea) 2006;17:38-47
  16. Bruce L, Zuraw BL. Urticaria and angioedema. In: Leung DY, Sampson HA, Geha RS, Szefler SJ, editors. Pediatric allergy; principles and practice. St. Louis: Mosby, 2003:574- 83
  17. Botey J, Cozzo M, Marin A, Eseverri JL. Monosodium glutamate and skin pathology in pediatric allergology. Allergol Immunopathol(Madr) 1988;16:425-8
  18. Nettis E, Colanardi MC, Ferrannini A, Tursi A. Sodium benzoate-induced repeated episodes of acute urticaria/angio-oedema: randomized controlled trial. Br J Dermatol 2004; 151:898-902 https://doi.org/10.1111/j.1365-2133.2004.06095.x
  19. Genton C, Frei PC, Pcoud A. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. J Allergy Clin Immunol 1985; 76:40-5 https://doi.org/10.1016/0091-6749(85)90802-4
  20. Supramaniam G, Warner JO. Artificial food additive intolerance in patients with angio-oedema and urticaria. Lancet 1986;18;2:907-9
  21. Ortolani C, Pastorello E, Fontana A, Gerosa S, Ispano M, Pravettoni V, et al. Chemicals and drugs as triggers of food-associated disorder. Ann Allergy 1988;60:358-66
  22. Simon RA. Additive-induced urticaria: experience with monosodium glutamate(MSG). J Nutr 2000;130(4 Suppl):1063S- 1066S
  23. Bettina W, Ulrike R, Alexander K. Chronic urticaria and infections. Curr Opin Immunol 2004;4:387-96 https://doi.org/10.1097/00130832-200410000-00010
  24. Kozel MM, Bossuyt PM, Mekkes JR, Bos JD. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol 2003;48:409-16 https://doi.org/10.1067/mjd.2003.142
  25. Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 2002;347:911- 20 https://doi.org/10.1056/NEJMra020100
  26. Wucherpfennig KW. Mechanisms for the induction of autoimmunity by infectious agents. J Clin Invest 2001;108:1097- 104 https://doi.org/10.1172/JCI14235
  27. Tebbe B, Geilen CC, Schulzke JD, Bojarski C, Radenhausen M, Orfanos CE. Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol 1996;34:685-6 https://doi.org/10.1016/S0190-9622(96)80086-7
  28. Jang MK, Kim JW, Kim SS, Seok SM, Kim KJ, Lee CJ. A prospective study for the prevalence of Helicobacter pylori infection in patients with chronic urticaria in Korea. Korean J Dermatol 1998;36:1005-11
  29. Wedi B, Kapp A. Helicobacter pylori infection in skin diseases: a critical appraisal. Am J Clin Dermatol 2002;3:273- 82 https://doi.org/10.2165/00128071-200203040-00005
  30. Kim JW, Kim HS, Chung KS. Influence of environmental living standards on Helicobacter pylori infection in Korean elementary school children. Korean J Pediatr Gastroenterol Nutr 2001;4:10-7
  31. Kang DH, Park HC, Choi DJ, Kim YK, Park JJ, Kim SS, et al. Helicobacter pylori seropositivity among healthy persons in metro-Inchon. Korean J Med 1999;56:576-80
  32. Wananukul S, Voramethkul W, Kaewopas Y. Prevalence of positive antinuclear antibodies in healthy children. Asian Pac J Allergy Immunol 2005;23:153-7
  33. Hila'rio MO, Len CA, Roja SC. Frequency of antinuclear antibodies in healthy children and adolescents. Clin Pediatr (Phila) 2004;43:637-42 https://doi.org/10.1177/000992280404300709
  34. Zauli D, Deleonardi G, Foderaro S, Grassi A, Bortolotti R, Ballardini G, et al. Thyroid autoimmunity in chronic urticaria. Allergy Asthma Proc 2001;22:93-5 https://doi.org/10.2500/108854101778250625
  35. Kauppine K, Juntune K, Lanki H. Urticaria in children. Allergy 1984;39:469-72 https://doi.org/10.1111/j.1398-9995.1984.tb01970.x
  36. Schnyder B, Helbling A, Pichler WJ. Chronic idiopathic urticaria: natural course and association with Helicobacter pylori infection. Int Arch Allergy Immunol 1999;119:60-3 https://doi.org/10.1159/000024176

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