Cold urticaria
ICD-10 L50.2 · ICD-11 EB01.1

Cold Urticaria in Children Under 18 When Initial Antihistamine-Based Therapy Has Not Achieved Full Symptom Control

Clinical Scenario

This protocol applies to paediatric patients under 18 years of age with cold urticaria. Management in this population follows the standard treatment algorithm but requires additional caution, individual assessment, and weight-adjusted dosing at every escalation step.

When First-Line Therapy Has Not Worked

First-line management in children combines avoidance of cold exposure with a weight-adjusted, regularly dosed 2nd generation H1-antihistamine. Escalation is indicated when this approach fails to achieve complete symptom control — specifically, a continuous UAS7 of 0 with absence of wheals and angioedema.

Next-Step Approach (Overview)

The structured escalation algorithm continues with further cautious, individually considered steps for children, starting with updosing of the 2nd generation H1-antihistamine. Subsequent add-on therapies may follow if control remains insufficient.

Corticosteroids, where considered at all, represent a very restricted measure in this age group. The full sequencing, add-on options, and paediatric-specific guidance are available in the complete protocol.

Treatment Goal

Complete symptom control, defined as a continuous UAS7 = 0 and a well-controlled disease state, with normalisation of quality of life.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/all.15090

We suggest using the same treatment algorithm with caution (eg, weight-adjusted dosage) in children with chronic urticaria.

All further steps should be based on individual considerations and be taken carefully as updosing of antihistamines, and further treatment options are not well studied in children.

In addition, a short course of corticosteroids as advised in the algorithm should be used as only a very restricted measure in children.

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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