The National Asthma Education and Prevention Program guidelines 20 recommend a stepwise approach to pharmacologic treatment starting with the most aggressive therapy necessary to achieve control, followed by a “step down” to the minimal therapy that will maintain control. The goals of pharmacologic therapy are to minimize daytime and nocturnal symptoms, the number of asthma episodes and the use of short-acting beta agonists, to improve PEF to 80 percent or more of personal best and to allow the child to maintain normal activities without producing adverse medication side effects. acute symptoms and before exercise to prevent exercise-induced bronchospasm.
Chronic urticaria has been uncommonly associated with systemic diseases such as collagen vascular disease or malignancy. In a meta-analysis by Kozel and colleagues, an underlying disease was considered to be the cause of chronic urticaria in only % of patients. 5 For patients with chronic urticaria, screening laboratory tests may be completed to help detect underlying illness. These tests can include a complete blood count with differential, erythrocyte sedimentation rate, urinalysis, and liver function tests. 29 Because thyroid autoimmunity has been associated with chronic urticaria, thyroid function tests including antimicrosomal and antithyroglobulin antibodies may be obtained. 35 If a connective tissue disease is suspected, antinuclear antibody and other serologic tests may be warranted. 35 A C4 level should be obtained in patients who experience angioedema without urticaria. If the C4 level is low, then C1 inhibitor level and function should be checked to evaluate further for possible hereditary or acquired angioedema.