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The RCPCH care pathway for children with urticaria, angio-oedema or mastocytosis: an evidence and consensus based national approach.
[cutaneous mastocytosis]
The
Royal
College
of
Paediatrics
and
Child
Health
(
RCPCH
)
Science
and
Research
Department
was
commissioned
by
the
Department
of
Health
to
develop
national
care
pathways
for
children
with
allergies
;
the
urticaria
,
angio-
oedema
or
mastocytosis
pathway
is
the
fifth
pathway
.
The
pathways
focus
on
defining
the
competences
required
to
improve
the
equity
of
care
received
by
children
with
allergic
conditions
.
The
urticaria
,
angio-
oedema
or
mastocytosis
pathway
was
developed
by
a
multidisciplinary
working
group
and
was
based
on
a
comprehensive
review
of
evidence
.
The
pathway
was
reviewed
by
a
broad
group
of
stakeholders
including
the
public
and
approved
by
the
Allergy
Care
Pathways
Project
Board
and
the
RCPCH
Clinical
Standards
Committee
.
Three
pathways
are
described
:
urticaria
with
or
without
angio-
oedema
,
angio-
oedema
without
weals
,
and
mastocytosis
.
The
results
are
presented
in
four
parts
:
evidence
review
,
mapping
,
external
review
and
core
knowledge
documents
.
Acute
urticaria
has
many
causes
and
is
often
not
allergic
in
origin
.
It
is
frequently
of
relatively
short
duration
and
easily
managed
with
antihistamines
alone
.
However
,
at
the
other
extreme
,
causes
of
chronic
urticaria
and
angio-
oedema
are
difficult
to
diagnose
and
treatment
can
be
complex
.
Thus
defining
the
competence
required
for
each
extreme
is
critical
to
ensure
optimal
care
.
The
evidence
review
identified
that
allergy
testing
and
thyroid
function
testing
were
helpful
in
the
investigation
of
chronic
urticaria
,
that
increasing
the
dose
of
antihistamine
was
effective
in
treating
urticaria
and
that
ciclosporin
A
and
prednisolone
were
effective
second
line
treatments
.
From
the
common
presentation
of
acute
(
intermittent
)
urticaria
to
the
uncommon
presentations
of
chronic
urticaria
,
angio-
oedema
and
cutaneous
mastocytosis
,
this
pathway
is
a
tool
to
assist
health
professionals
to
differentiate
and
manage
these
conditions
.
Diseases
Validation
Diseases presenting
"thyroid function testing"
symptom
cutaneous mastocytosis
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