This protocol applies to paediatric patients — those under 18 years of age — presenting with chronic urticaria. Managing urticaria in this age group requires careful attention to drug licensing status, age-specific experience, and appropriate weight- and age-adjusted use of therapies.
Chronic urticaria in patients under 18 years follows the same overall treatment framework as in adults, but the approach must be applied with caution given paediatric-specific considerations around safety profiles and approved use in children.
The recommended starting point is a standard-dosed 2nd generation H1-antihistamine selected for its established efficacy and safety in the paediatric population. First-generation H1-antihistamines are not recommended due to their less favourable safety profile compared to 2nd generation agents. The specific agent and further management steps are detailed in the full protocol.
The aim of treatment is complete symptom control — continuing until the disease has resolved, as efficiently and safely as possible.
DOI: 10.1111/all.70210
We suggest using the same treatment algorithm with caution (e.g., according to licensing status, experience for use in children, weight-and age-adjusted dosage) in children with chronic urticaria.
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.
Second-generation H1-antihistamines with proven efficacy and safety in the pediatric population include bilastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and rupatadine.
The goal of treatment is to treat the disease until it is gone, as efficiently and as safely as possible, aiming at a continuous complete control (consistently UAS = 0/UCT = 16) and a normalization of quality of life.
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