ESPE Abstracts

Introduction: Chronic urticaria (CU) affects about 0.3% of pediatric subjects worldwide. Most cases have not identifiable triggers and are classified as chronic spontaneous urticaria (CSU). Etiopathogenesis is complex and the role of thyroid diseases has been widely studied. Indeed, subjects with CSU are held to often have autoimmune disorders, including autoimmune thyroid diseases. This study aims to analyze the possible association of thyroid autoimmunity in pediatric patients with CSU and to evaluate the correlation between the severity of urticaria and the degree of thyroid dysfunction.

Materials and Methods: We conducted a retrospective, monocenter, observational study at our Pediatric Unit, from January 2020 to January 2024. The following demographic and clinical data were gathered at the first outpatient visit: age, sex, race, age of CSU onset, autoimmune and/or atopic comorbidities, Weekly Urticaria Activity Score (UAS-7) and values of Thyroid-stimulating hormone (TSH), free thyroxin (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase antibodies (anti-TPO abs), anti-thyroglobulin antibodies (anti-TG abs).

Results: 34 Caucasian pediatric subjects (mean age 10.7 ± 4.1 years old, 56% female) affected by CSU were included in the final analysis. 1/34 (3%) presented family history of thyroid diseases, while 14/34 (41%) presented other atopic diseases and 2/34 (6%) coeliac disease. The mean age at CSU onset was 8.4 ± 3.9 years old, while the UAS-7 score at the time of the outpatient visit was 20.1 ± 6.3. Laboratory exams showed the following mean values: TSH 2.5 ± 1.5; FT4 13.3 ± 4.7; FT3 4.6 ± 2.0; anti-TPO abs 31.1 ± 59.5; anti-TG abs 37.9 ± 89.3. The analysis of data collected documented a statistically significant correlation between TSH and UAS-7 score (P.048). No significant association were found between FT4, FT3, antibody levels and the age of CSU onset, nor between them and UAS-7.

Conclusions: CSU may anticipate the development of a thyroid disease even by several years, especially in patients with a greater severity of urticarial lesions. Although signs and symptoms of thyroid diseases are absent, the study of thyroid function and the hormonal profile may be important in this group of patients to make an early diagnosis and prevent the development of thyroid complications with the start of the appropriate treatment. Further long-term studies, including a larger sample size, are certainly needed.