Ayşe AYDOĞDU, Tuğba ARIKOĞLU, Semanur KUYUCU, Özlem TEZOL, Sehra Birgul BATMAZ

Çocukluk Çağındaki Kronik Ürtikerli Olguların EtiyolojikAçıdan Değerlendirilmesi

Amaç: Kronik ürtikerin etiyolojisi çoğunlukla idiyopatiktir. Çocukluk çağı kronik ürtikeri ile ilgili literatürde sınırlı veri mevcuttur. Çalışmada, çocuklarda kronik ürtikerin etiyolojisinde rol oynayabilecek faktörler ve ilişkili klinik ve laboratuvar bulguların araştırılması amaçlandı.Gereç ve Yöntemler: Kliniğimizde kronik ürtiker tanısı alan 18 yaş altı 80 hasta retrospektif olarak incelendi. Kronik ürtikerli hastaların klinik özellikleri, laboratuvar bulguları, atopi, enfeksiyon, otoimmünite ve fiziksel ürtikere yönelik tetkikleri değerlendirildi.Bulgular: Kronik ürtiker tanısı ile izlenen 80 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 10.2±4.1 yıldı. 41’i (%51.2) kızdı. Hastaların %53.7’sinde fiziksel ürtiker, %46.3’ünde kronik spontan ürtiker tesbit edildi. En sık saptanan komorbid hastalıklar sırasıyla; otoimmün hastalık (%10) (5 otoimmün tiroidit, 1 juvenil romatoid artrit, 1 diyabet, 1 akut romatizmal kardit), kronik gastrit veya reflü (%8.7) ve nonsteroidal anti-inflamatuvar ilaç (NSAİ) allerjisi (%5) idi. Kronik ürtikerli hastaların %23.7’sinde atopi, %16.4’ünde helikobakter pylori pozitifliği, %20.3’ünde tiroid otoantikor varlığı, %33.3’ünde antinükleer antikor (ANA) pozitifliği, %25’inde gıda katkı maddesi ile ilişkili ürtiker, %6.7’sinde dışkıda parazit saptandı. Otolog serum deri testi pozitifliği (OSDT) %37.8 olarak bulundu. OSDT pozitif (n=14) ve negatif (n=23) hastalar karşılaştırıldığında; yaş, cinsiyet, atopi, otoimmün hastalık varlığı, ANA pozitifliği, tiroid otoantikor varlığı ve Helikobakter pylori pozitifliği açısından gruplar arasında anlamlı bir fark saptanmadı. Fiziksel ürtiker nedenleri arasında en sık dermografizm (%45) görülürken, %32.4’ünde kolinerjik ürtiker, %8.7’sinde gecikmiş basınç ürtikeri, %8’inde soğuk ürtiker ve %4.7’sinde solar ürtiker tesbit edildi.Sonuç: Çocuklarda kronik ürtiker etiyolojisinde otoimmünite ve fiziksel ürtiker önemli bir yer tutmaktadır. Şüpheli olgularda fiziksel ürtiker testlerinin ve ayrıntılı incelemelerin yapılması kronik ürtikerli olguların daha iyi bir şekilde yönetimine katkı sağlayacaktır.

The Etiological Evaluation of Patients with Chronic Urticaria in Childhood

Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhoodchronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiologyof chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years whoattended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests foratopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as havingchronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were;autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumaticcarditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7%had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody(ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites.Autologous serum skin test (ASST) results were positive in 37.8% of the patients. The comparison of patients with positive and negativeASST showed no statistically significant differences in terms of age, gender, presence of atopy, autoimmune disease, ANA positivity,presence of antithyroid antibody and H. pylori positivity. Among the causes of physical urticaria, dermographism, cholinergic urticaria,delayed pressure urticaria, and cold and solar urticaria were found in 45%, 32.4%, 8.7%, 8% and 4.7%, respectively. Conclusion: The etiology of childhood chronic urticaria is mainly related to autoimmunity and physical urticaria. Identification of clinicalfeatures and possible causes will contribute to a better management of chronic urticaria in children.

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