Management of Pediatric Chronic Spontaneous Urticaria: Current Evidence and Emerging Therapies
5 affiliations
- 1Pediatric Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
- 2Department of Dermatology, University of California, Irvine, CA USA
- 3Department of Pediatrics, University of California, Irvine, CA USA
- 4Division of Dermatology, Rady Children’s Hospital, Orange County, CA USA
- 5Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Abstract
Pediatric chronic spontaneous urticaria is a heterogeneous, mast cell-driven inflammatory disorder characterized by recurrent pruritic wheals, angioedema, or both persisting for more than 6 weeks, with a significant impact on patient and family quality of life. Although most children achieve disease control with second-generation H1-antihistamines, a substantial proportion remains symptomatic despite dose escalation and requires advanced treatment. Based on a structured search of PubMed/MEDLINE, Google Scholar, ClinicalTrials.gov, and regulatory sources covering publications from 2010 to 2026, this narrative review synthesizes current evidence on established and emerging therapeutic options for pediatric chronic spontaneous urticaria, with particular emphasis on age-specific efficacy, safety, regulatory status, practical treatment positioning, and the translation of adult evidence to pediatric practice. Omalizumab remains the most established second-line biologic in adolescents (aged ≥ 12 years). The recent approval of dupilumab for children aged ≥ 2 years, based on pharmacokinetic extrapolation from adult and adolescent trials, represents the first biologic option for younger children with antihistamine-refractory chronic spontaneous urticaria. Emerging therapies, including Bruton tyrosine kinase inhibitors (remibrutinib, now US Food and Drug Administration and European Commission approved for adults), anti-KIT antibodies (barzolvolimab), and Mas-related G-protein coupled receptor X2 antagonists, are expanding the therapeutic paradigm, although pediatric data remain limited. We also propose an age-adapted treatment algorithm integrating current regulatory approvals, evidence quality, and age-specific safety considerations. The availability of approved biologic therapy from 2 years of age marks a paradigm shift in this rapidly evolving field; however, dedicated pediatric trials, validated biomarkers for endotype-guided treatment, and long-term safety data in children remain critical unmet needs.
Related
- Type 2 Inflammation in Chronic Spontaneous Urticaria: Presentation, Role, and Management.
- Treatment Choice and Cardiovascular Risk in Chronic Spontaneous Urticaria.
- Real‐World Outcomes of Omalizumab for Chronic Spontaneous Urticaria in a New Zealand Regional Dermatology Service
- Lower Serum SCCA2 Detectability in Chronic Spontaneous Compared with Chronic Inducible Urticaria: A Prospective Observational Study
- Efficacy and safety of acupuncture therapy for chronic spontaneous urticaria: a network meta-analysis based on randomized controlled trials
BibTeX
@article{tedeschi2026management,
title = {{Management of Pediatric Chronic Spontaneous Urticaria: Current Evidence and Emerging Therapies}},
author = {Micol Tedeschi and Maria Gnarra Buethe and Gian Luigi Marseglia and Amelia Licari},
journal = {Paediatric Drugs},
year = {2026},
month = oct,
doi = {10.1007/s40272-026-00782-1},
url = {https://doi.org/10.1007/s40272-026-00782-1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Management of Pediatric Chronic Spontaneous Urticaria: Current Evidence and Emerging Therapies
AU - Micol Tedeschi
AU - Maria Gnarra Buethe
AU - Gian Luigi Marseglia
AU - Amelia Licari
PY - 2026
DA - 2026/10/22
JO - Paediatric Drugs
DO - 10.1007/s40272-026-00782-1
UR - https://doi.org/10.1007/s40272-026-00782-1
AB - Pediatric chronic spontaneous urticaria is a heterogeneous, mast cell-driven inflammatory disorder characterized by recurrent pruritic wheals, angioedema, or both persisting for more than 6 weeks, with a significant impact on patient and family quality of life. Although most children achieve disease control with second-generation H1-antihistamines, a substantial proportion remains symptomatic despite dose escalation and requires advanced treatment. Based on a structured search of PubMed/MEDLINE, Google Scholar, ClinicalTrials.gov, and regulatory sources covering publications from 2010 to 2026, this narrative review synthesizes current evidence on established and emerging therapeutic options for pediatric chronic spontaneous urticaria, with particular emphasis on age-specific efficacy, safety, regulatory status, practical treatment positioning, and the translation of adult evidence to pediatric practice. Omalizumab remains the most established second-line biologic in adolescents (aged ≥ 12 years). The recent approval of dupilumab for children aged ≥ 2 years, based on pharmacokinetic extrapolation from adult and adolescent trials, represents the first biologic option for younger children with antihistamine-refractory chronic spontaneous urticaria. Emerging therapies, including Bruton tyrosine kinase inhibitors (remibrutinib, now US Food and Drug Administration and European Commission approved for adults), anti-KIT antibodies (barzolvolimab), and Mas-related G-protein coupled receptor X2 antagonists, are expanding the therapeutic paradigm, although pediatric data remain limited. We also propose an age-adapted treatment algorithm integrating current regulatory approvals, evidence quality, and age-specific safety considerations. The availability of approved biologic therapy from 2 years of age marks a paradigm shift in this rapidly evolving field; however, dedicated pediatric trials, validated biomarkers for endotype-guided treatment, and long-term safety data in children remain critical unmet needs.
SN - 1174-5878
SN - 1179-2019
ER -