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Background <p>Chronic spontaneous urticaria (CSU) is characterized by the presence of recurrent wheals and/or angioedema lasting over six weeks. While more prevalent in adults than children, treatment strategies often rely on adult-based guidelines, with limited pediatric-specific data. Pediatric CSU has not been explored in terms of immunology and therapeutics especially in Indian context. This study aimed to compare the clinical, immunological profiles and treatment responses of adult and pediatric CSU patients to identify age-related differences and optimize therapeutic approaches.</p> Methods <p>This retrospective analysis analysed clinical data of 236 CSU patients from January 2020 to July 2024. Patients were stratified into adults (G1: &gt;18 years) and pediatric groups (G2A: 0–11 years; G2B: 12–18 years). Parameters analyzed included demographic details, laboratory markers- C-reactive protein (CRP), d-dimer, serum Immunoglobulin E (serum IgE), Anti Thyroid Peroxidase antibodies (anti-TPO antibodies), treatment modalities and response assessed via Urticaria Activity Score (UAS7). Refractory CSU (CRU) was defined as inadequate response to fourfold up-dosing of second-generation antihistamines (sg-AH), warranting second-line agents—omalizumab or cyclosporine (CsA).</p> Results <p>Adults (<i>n</i> = 176) had significantly longer disease duration, higher rates of angioedema, and more frequent elevations in CRP, d-dimer, and anti-TPO, suggestive of autoimmune involvement. In contrast, pediatric patients (<i>n</i> = 60) demonstrated higher serum IgE levels. Response to standard-dose sg-AH was significantly better in children (58.3%) than adults (28.9%) (<i>p</i> &lt; 0.01). Adults with CRU responded more favorably to CsA, while pediatric patients showed better outcomes with omalizumab. Non-responsiveness to sg-AH was associated with elevated CRP, d-dimer, serum IgE, and anti-TPO positivity. Subgroup analysis indicated no significant differences in treatment responses between children and adolescents within the pediatric group.</p> Conclusion <p>This study highlights significant age-related differences in CSU presentation and treatment response. Adults demonstrated features of type 2b autoimmune CSU and responded well to cyclosporine, whereas pediatric CSU predominantly showed an autoallergic profile, benefiting more from omalizumab. Recognizing these distinct endotypes and immunologic profiles is essential for personalizing treatment and improving outcomes across age groups.</p>

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Unveiling age-related differences in chronic spontaneous urticaria: a retrospective analysis comparing clinical, immunological profile, and treatment responses among pediatric and adult patients with chronic spontaneous urticaria

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Muthu Sendhil Kumaran,
  • Janaani P,
  • Rucha Herlekar,
  • Davinder Parsad

摘要

Background

Chronic spontaneous urticaria (CSU) is characterized by the presence of recurrent wheals and/or angioedema lasting over six weeks. While more prevalent in adults than children, treatment strategies often rely on adult-based guidelines, with limited pediatric-specific data. Pediatric CSU has not been explored in terms of immunology and therapeutics especially in Indian context. This study aimed to compare the clinical, immunological profiles and treatment responses of adult and pediatric CSU patients to identify age-related differences and optimize therapeutic approaches.

Methods

This retrospective analysis analysed clinical data of 236 CSU patients from January 2020 to July 2024. Patients were stratified into adults (G1: >18 years) and pediatric groups (G2A: 0–11 years; G2B: 12–18 years). Parameters analyzed included demographic details, laboratory markers- C-reactive protein (CRP), d-dimer, serum Immunoglobulin E (serum IgE), Anti Thyroid Peroxidase antibodies (anti-TPO antibodies), treatment modalities and response assessed via Urticaria Activity Score (UAS7). Refractory CSU (CRU) was defined as inadequate response to fourfold up-dosing of second-generation antihistamines (sg-AH), warranting second-line agents—omalizumab or cyclosporine (CsA).

Results

Adults (n = 176) had significantly longer disease duration, higher rates of angioedema, and more frequent elevations in CRP, d-dimer, and anti-TPO, suggestive of autoimmune involvement. In contrast, pediatric patients (n = 60) demonstrated higher serum IgE levels. Response to standard-dose sg-AH was significantly better in children (58.3%) than adults (28.9%) (p < 0.01). Adults with CRU responded more favorably to CsA, while pediatric patients showed better outcomes with omalizumab. Non-responsiveness to sg-AH was associated with elevated CRP, d-dimer, serum IgE, and anti-TPO positivity. Subgroup analysis indicated no significant differences in treatment responses between children and adolescents within the pediatric group.

Conclusion

This study highlights significant age-related differences in CSU presentation and treatment response. Adults demonstrated features of type 2b autoimmune CSU and responded well to cyclosporine, whereas pediatric CSU predominantly showed an autoallergic profile, benefiting more from omalizumab. Recognizing these distinct endotypes and immunologic profiles is essential for personalizing treatment and improving outcomes across age groups.