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The RCPCH care pathway for children with Urticaria, Angio-oedema or Mastocytosis: an evidence and consensus based national approach
  1. Susan Leech1,
  2. Clive Grattan2,
  3. Kate Lloyd3,
  4. Sarah Deacock4,
  5. Lynette Williams5,
  6. Andrew Langford6,
  7. John Warner7 on behalf of the Science and Research Department, Royal College of Paediatrics and Child Health
  1. 1Department of Paediatric Allergy, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
  3. 3Science and Research Department, Royal College of Paediatrics and Child Health, London, UK
  4. 4Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  5. 5Royal Shrewsbury Hospital NHS Trust, Shrewsbury, UK
  6. 6Skin Care Campaign, UK
  7. 7Department of Paediatrics, Imperial College, St Mary's Hospital Campus, London, UK
  1. Correspondence to Dr Susan Leech, Department of Paediatric Allergy, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; susan.leech{at}


Aims 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.

Method 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.

Results 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.

Conclusions 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.

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  • Funding This project was funded by the Department of Health.

  • Competing interests CG: CSL Behring, GSK; AL: Stiefel, GSK, Reckitt Benckiser, Dermal, Leo & Galderma; LW: GSK, MSD; JW: Novartis, Danone, Mead Johnson, Airsonette, Merck, Allergy Therapeutics, GSK, AstraZeneca. No other members declared a financial interest.

  • Provenance and peer review Not commissioned; not externally peer reviewed.