Anti-IgE for chronic urticaria - are children little adults after all?

Features of the functioning of innate immunity in children with chronic idiopathic urticaria

Aim. To study the features of the functioning of innate immunity in children with chronic idiopathic urticaria.

Materials and methods. The study included 28 children of both sexes aged 6–16 years with chronic idiopathic urticaria (CIU). The median age of the patients was 8 years (p = 0.045). Clinical research methods included an analysis of complaints and anamnestic data, as well as an objective examination of the child (dynamics of urticaria, severity of itching, the presence of angioedema). Immunological techniques included determination of the number of monocytes expressing CD14+CD282+, CD14+CD284+, CD14+CD289+, the number of peripheral blood lymphocytes expressing CD3+CD16+, the levels of immunoglobulin (Ig) E, lactoferrin, interferon (IFN) γ, interleukin (IL)4, and IL-6, and a nitroblue tetrazolium test.

Results. In the course of the study, an increase in the expression of Toll-like receptors TLR2 and TLR4 by monocytes, a decrease in the expression of TLR9 by monocytes, a significant rise in lactoferrin levels, a slight decrease in the number of natural killer (NK) cells, a decrease in microbicidal activity and adaptive reserves, a rise in IgE levels, a decrease in IL-4 levels, and an increase in IFNγ and IL-6 were revealed in children with CIU.

Conclusion. The immunological changes revealed during the study indicate multidirectional expression of Toll-like receptors, disturbances in the work of the cellular components of innate immunity, and a launch of a proinflammatory cytokine cascade in children with CIU, which can serve as a mainstay for the development of new schemes for personalized therapy of CIU in children.

Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

Childhood urticaria is not rare, although its persistence is less frequent. In children, chronic spontaneous urticaria (CSU) is associated with comorbidities, including asthma, allergic rhinitis, or atopic dermatitis, and many children with CSU have a family history of atopy. The therapeutic approach to CSU in children is the same one recommended by international guidelines for treatment of chronic urticaria in adults. In the European Union, according to the European Medicine Agency, omalizumab is the add-on drug of choice for the management of CSU in adult and adolescent patients (from 12 years of age) with inadequate response to H1 antihistamine therapy. In addition, in children (6 to <12 years of age), it is the add-on therapy of choice to improve asthma control. The management of children with urticaria under 12 is a therapeutic area with few certainties, where omalizumab can be administered only "off-label."

Treatment of allergic children - Where is the progress (for the practicing allergist)?

For any kind of therapeutic intervention in allergic diseases such as environmental control, pharmacological, or immunomodulating treatment including educational programs, children are addressed separately from adults. Health authorities like the Food and Drug Administration in the United States of America or the European Medicine Agency in Europe request a specific 'Pediatric investigational plan' with studies addressing dose-response relationship, safety, and efficacy for infants, children, and adolescents. During the last 2 years, promising advances have been reported for the treatment of a variety of allergic and immunologic disorders. This review summarizes the progress in the treatment of pediatric asthma and allergic diseases, based on publications of approximately the last 2.5 years (end of 2013 until May 2016) in and beyond this journal. Meanwhile, it highlights areas with promising novel therapeutic approaches, which are likely to change treatment for allergic children in the near future.