Risk Factors for Progression to Chronicity or Recurrent Episodes in Pediatric Acute Urticaria: A 1-Year Cohort Study.

BACKGROUND: Acute urticaria (AU) is common and often considered self-limiting in children; however, a subset may progress to chronic spontaneous urticaria (CSU) or develop recurrent AU. Clinical characteristics associated with these unfavorable outcomes remain poorly characterized. METHODS: In this single-center retrospective cohort study, 475 children (<18 years) with AU presenting to dermatology settings were included. Demographic, clinical, and laboratory data were extracted from electronic medical records. Personal and family histories of atopy were confirmed, and 1-year outcomes were assessed via structured telephone follow-up. Independent risk factors were identified using Firth penalized multivariable logistic regression. RESULTS: Follow-up was completed for 358 of 475 (75.4%) patients. Median age was 4.25 years, with 51% being male. At 1 year, 50 patients (14.0%) progressed to CSU and 37 patients (10.3%) experienced recurrent AU. Firth penalized multivariable analysis identified non-first-episode presentation (CSU: aOR 7.89, 95% CI 3.54-17.92; recurrent AU: aOR 6.73, 95% CI 2.57-17.31) and family history of CSU (CSU: aOR 4.35, 95% CI 1.27-13.65; recurrent AU: aOR 8.85, 95% CI 2.76-27.19) as independent predictors of both adverse outcomes. Family history of asthma was associated with CSU progression (aOR 32.26, 95% CI 1.67-477.76), and family history of chronic inducible urticaria was associated with recurrent AU (aOR 9.07, 95% CI 2.02-40.99); however, these estimates were imprecise because of small exposed case numbers. Notably, systemic corticosteroid use was not independently associated with either adverse outcome. CONCLUSION: Recurrent AU, in addition to CSU progression, is an important 1-year outcome after pediatric AU. Non-first-episode AU and family history of CSU are readily ascertainable predictors that enable early risk stratification and follow-up. The single-center retrospective design and loss to follow-up should be considered when interpreting the generalizability of these findings.