title: A stepwise approach in the management of chronic spontaneous urticaria in children.
abstract: BACKGROUND
  There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies.
  
  
  OBJECTIVE
  Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children.
  
  
  METHODS
  A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study.
  
  
  RESULTS
  Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control.
  
  
  CONCLUSIONS
  We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.
authors: Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Xin Hui Magdeline
authors: XH
authors: Lee
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Lin Xin
authors: LX
authors: Ong
authors: Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Jing Yi Vanessa
authors: JY
authors: Cheong
authors: Duke-NUS Graduate Medical School Singapore, Singapore 169857, Singapore.
authors: Rehena
authors: R
authors: Sultana
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Rajeshwar
authors: R
authors: Rao
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Hwee Hoon
authors: HH
authors: Lim
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Xiao Mei
authors: XM
authors: Ding
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Wen Yin
authors: WY
authors: Loh
authors: Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Monika
authors: M
authors: Punan
authors: Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore.
authors: Wen Chin
authors: WC
authors: Chiang
keywords: Algorithms; Child; Chronic Urticaria; Histamine Antagonists