What Drives Diagnostic Testing in Pediatric Acute Urticaria? A Real-World Cohort Study
Melek Yorgun Altunbaş11Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
Objectives: Pediatric acute urticaria (AU) is a common reason for visits to emergency and outpatient clinics. Although international guidelines recommend against routine diagnostic testing for AU, such tests remain frequently performed in clinical practice. We aimed to evaluate diagnostic test use in pediatric AU, identify factors associated with test ordering, and assess the impact of testing on clinical management. Methods: This retrospective observational cohort study included children aged 0-18 who presented to the pediatric emergency department or outpatient clinics at a tertiary care hospital with AU (with or without angioedema) over a 2-year period. Demographic and clinical data, including diagnostic test details, management strategies and referral patterns, were extracted from electronic medical records. The primary outcome was whether diagnostic testing was performed during the clinical course. The secondary outcome was whether diagnostic tests influenced clinical management. To identify independent predictors of diagnostic test use, we used multivariable logistic regression. Results: Of the 300 children included (median age 6.1 years), 214 (71.3%) underwent diagnostic testing. Testing was more common among patients who did not receive pharmacological treatment at first contact than among those who did (85.5% vs 67.2%, p=0.006). In multivariable analysis, referral before starting treatment was the strongest predictor of diagnostic testing (adjusted odds ratio [aOR], 3.21; 95% CI, 1.98-5.22). Conversely, initiating treatment at first contact (aOR 0.48; 95% CI 0.29-0.79) and being managed by pediatric allergy-immunology specialists (aOR 0.39; 95% CI 0.21- 0.71) were associated with lower testing rates. Despite the common use of testing, it led to a documented change in clinical management in only 7 cases (2.3%). Confirmed IgE-mediated food allergy was identified in five children (1.7%), all of whom had a clear history of immediate reactions triggered by suspected food allergens. Conclusion: In pediatric AU, diagnostic testing is frequently performed, but it rarely alters patient management. The way tests are ordered appears to be influenced more by care pathways and treatment timing than by specific clinical signs. Starting treatment early based on symptoms and making targeted referrals might help reduce unnecessary tests in routine pediatric care. Keywords: Acute urticaria, care pathways, diagnostic testing
Cite This Article
Yorgun Altunbaş M. What Drives Diagnostic Testing in Pediatric Acute Urticaria? A Real-World Cohort Study. EJMI. 2026; 10(4): 523-530
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