Editorial comment on “An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An <scp>EAACI</scp> Task Force report”

Stefania Arasi Results of the study show an appropriate focused diagnostic work-up, including complete blood counts, CRP, and/or ESR, as well as total IgE and IgG anti-TPO levels. Yet two opposing trends persist: underuse of standardized provocation testing when chronic inducible urticaria (CIndU) is suspected, and overuse of laboratory diagnostic tests with yet limited evidence. Less than one in five clinicians routinely perform CIndU testing, mostly due to equipment, training, or time limits. These findings highlight the need for better implementation of practical approaches for the pediatric CU population. The study further reveals a common misconception that environmental factors play a major causative role in chronic urticaria, whereas their relevance is far greater in acute urticaria, where infectious triggers are more often the primary drivers. Although there is a recognizable connection between acute urticaria and acute infections, the progression from acute to chronic urticaria remains unclear. This resonates with recent observations by Yildirim et al. who found that disease severity in acute urticaria can predict its progression to chronicity, emphasizing the importance of early, accurate diagnosis and communication between clinicians and families.4 This once again highlights the importance of educational programs for patients and their families. Most HCPs apply second-generation antihistamines with further up-dosing two- to fourfold if standard dosing fails, although the timing and escalation strategies vary. The use of omalizumab (anti-IgE therapy) in children, particularly those under 12 years old, remains limited. This caution is understandable given limited pediatric trial data and the off-label status of omalizumab for children under 12 years old. Many HCPs do not prescribe omalizumab in children under 5 years old (77.6%), 6–11 years old (45%), and adolescents (24.7%). However, emerging evidence suggests, that biologics are highly effective in pediatric CU. Alomari et al.5 in their meta-analysis reported a high response rate of 88% and an excellent safety profile for omalizumab in pediatric CU, supporting its use as a next-line therapy in antihistamine-refractory cases. The underuse of biologics and continued reliance on systemic corticosteroids by 20% of respondents indicates the need for targeted educational efforts and more pediatric-specific clinical data. Taken together, the EAACI Task Force report highlights significant unmet needs in harmonizing pediatric CU care. Key priorities include standardizing diagnostic procedures, rationalizing the use of laboratory tests, and increasing usage of targeted treatment options to avoid long-term corticosteroid use. This EAACI Task Force report thus represents an essential milestone for the current state of pediatric urticaria care. Bridging the gap between guidelines and practice through education, harmonization, and research will be key to improving outcomes for children living with urticaria. Polina Pyatilova: Writing – original draft; writing – review and editing; conceptualization. Agnes Leung: Conceptualization; supervision; writing – review and editing. Philippe Eigenmann: Supervision; conceptualization; writing – review and editing. None declared.