Cold Urticaria Treatment in Children and Adolescents Under 18 Years

Managing cold urticaria in pediatric patients requires a carefully adapted approach. Children under 18 need weight-adjusted treatment and agent selection with a demonstrated pediatric safety record — the regimen for adults cannot be applied directly.

Patient scenario

Cold urticaria in a patient aged under 18 years. The treatment algorithm follows the same principles as in adults but must be applied with particular caution, including weight-adjusted dosing and use of agents with established efficacy and safety in the pediatric population.

Treatment approach

First-line management combines avoidance of cold exposure with regular, weight-adjusted use of a second-generation H1-antihistamine — specific agent selection and the complete structured regimen are available in the full protocol.

Treatment goals

Complete symptom control — continuous UAS7 = 0
Absence of wheals and angioedema

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/all.15090

In CIndU, avoidance of specific and definite triggers for the development of signs and symptoms, for example, cold in cold urticaria, can reduce disease activity.
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.
2nd generation H1-antihistamines with proven efficacy and safety in the pediatric population include bilastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and rupatadine.
We suggest using the same treatment algorithm with caution (eg, weight-adjusted dosage) in children with chronic urticaria.
The goal of treatment is to treat the disease until it is gone and as efficiently and safely as possible aiming at a continuous UAS7 = 0, complete control and a normalization of quality of life.

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