Prevalence of atopic diseases in children with papular urticaria

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Mehmet Halil Celiksoy
Abdullah Hakan Ozmen
Erdem Topal


insect byte, papular urticaria, atopy, asthma, allergic rhinitis, atopic dermatitis, children


Background: Papular urticaria is a hypersensitivity reaction characterized by chronic and recurrent papular erythema. It occurs as a result of the bites of mosquitoes, fleas, bed bugs, and other insects; and it is generally seen in children. This study examines the prevalence of atopic diseases in patients with papular urticaria.

Methods: The medical records of 130 pediatric patients with the diagnosis of papular urticaria between August 2017 and August 2019, whose disease progression was followed in two tertiary care centers, were reviewed retrospectively. The patients were divided into two groups: under 5 and above 5 years old. The prevalence of the atopic disease in children with papular urticaria was compared with those in age-matched controls without papular urticaria.

Results: The study included 130 patients who were diagnosed with papular urticaria (64 males, 66 females, median age: 60 months). The prevalences of atopic disease, recurrent wheezing, and atopic dermatitis were higher in the group under 5 years old with papular urticaria than in the same-age control group (p=0.001, 0.002, and 0.001, respectively). The prevalences of atopic disease, asthma, allergic rhinitis, and atopic dermatitis were higher in the group above 5 years old with papular urticaria than in the same-age control group (p=0.001, 0.001, 0.001, and 0.007, respectively).

Conclusions: Many children with papular urticaria are atopic children. These patients should be assessed not only in terms of papular urticaria but also in terms of comorbid atopic diseases.

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1. Demain JG. Papular urticaria and things that bite in the night. Curr Allergy Asthma Rep. 2003;3:291–303. 10.1007/s11882-003-0089-3

2. Halpert E, Borrero E, Ibañez-Pinilla M, Chaparro P, Molina J, Torres M, et al. Prevalence of papular urticaria caused by flea bites and associated factors in children 1-6 years of age in Bogotá, D.C. World Allergy Organ J. 2017;10:36. 10.1186/s40413-017-0167-y

3. Jayakar T, Selva PSK, Manoharan D, Ashok KN, Cynthia S, Ashwak A. Papular urticaria–an early of atopic march. Sudanese J Dermatol. 2014;8:53–57. 10.4314/sjd.v8i2.68354

4. Reed CE. The natural history of asthma. J Allergy Clin Immunol. 2006;118:543–548. 10.1016/j.jaci.2006.06.020

5. Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010;105:99–106. 10.1016/j.anai.2009.10.002

6. Avaliable at Accessed April 1, 2020.

7. Klimek L, Bachert C, Pfaar O, et al. ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergo J Int. 2019;28:255–276. 10.1007/s40629-019-00110-9

8. Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. 2003;49:1088–1095. 10.1016/S0190-9622(03)02539-8

9. Howard R, Frieden IJ. Papular urticaria in children. Pediatr Dermatol. 1996;13:246–249. 10.1111/j.1525-1470.1996.tb01212.x

10. Kohut T, Orozco A. Dermatology. In: Hughes HK, Kahl LK, editors. Harriet Lane handbook. 21st ed. Philadelphia: Elsevier; 2018. p. 203–228.

11. Singh S, Mann BK. Insect bite reactions. Indian J Dermatol Venereol Leprol. 2013;79:151–1 64. 10.4103/0378-6323.107629

12. Stibich AS, Schwartz RA. Papular urticaria. Cutis. 2001;68: 89–91.

13. Ferrante G, La Grutta S. The burden of pediatric asthma. Front Pediatr. 2018;6:186. 10.3389/fped.2018.00186

14. Chong SN, Chew TF. Epidemiology of allergic rhinitis and associated risk factors in Asia. World Allergy Organ J. 2018;11:17. 10.1186/s40413-018-0198-z

15. Aksu K, Arga M, Asilsoy S, Avcil S, Çetinkaya F, Civelek E, et al. Diagnosis and management of atopic dermatitis: national guideline 2018. Asthma Allergy Immunol. 2018;16 (Suplement 2): 1–95.

16. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J. 1998;12:315–335. 10.1183/09031936.98.12020315

17. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, et al. The International Study of asthma and allergies in childhood (ISAAC) phase three: a global synthesis. AllergolImmunopathol (Madr). 2013;41:73–85. 10.1016/j.aller.2012.03.001

18. Kurt E, Metintas S, Basyigit I, et al. Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults. Eur Respir J. 2009;33(4):724–733. 10.1183/09031936.00082207

19. Brozek G, Lawson J, Szumilas D, Zejda J. Increasing prevalence of asthma, respiratory symptoms, and allergic diseases: four repeated surveys from 1993-2014. Respir Med. 2015;109:982–990. 10.1016/j.rmed.2015.05.010

20. Topal E, Kaplan F, Türker K, Kutlutürk K, Gözükara Bag H. The prevalence of allergic diseases and associated risk factors in the 6-7 age children who are living in Malatya, Turkey. Asthma Allergy Immunol. 2017;15:129–134.