This protocol addresses paediatric patients under 18 years of age with acute urticaria who remain symptomatic after an appropriate first-line antihistamine — wheals and pruritus have not been fully eliminated.
Children and adolescents (age under 18 years) with acute urticaria.
The first-line approach — a weight- and age-adjusted 2nd-generation H1-antihistamine (bilastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, or rupatadine) — did not achieve the goal of complete symptom control: wheals or pruritus persist (UAS above zero). Note that 1st-generation H1-antihistamines are not recommended as first-line treatment in children due to their inferior safety profile.
For children who have not responded fully to antihistamine therapy, the protocol considers a short course of corticosteroids — but only as a very restricted measure, subject to specific clinical criteria. The complete decision algorithm and prescribing guidance are available in the full protocol.
DOI: 10.1111/all.70210
1st generation H1-antihistamines have an inferior safety profile compared with 2nd generation H1-antihistamines, and are, therefore, not recommended as first line treatment in children with urticaria.
In addition, a short course of corticosteroids as advised in the algorithm should be used only as a very restricted measure in children.
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