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A new study on urticaria plus some other refs on the subject (the last suggesting no link with adult urticaria).  

Incidentally this new study does not seem to indicate how DH was ruled out (but I have seen only the abstract).

Charlotte,Oxford, UK

Chronic urticaria and associated coeliac disease in children: A case control study 

Pediatric Allergy and Immunology Volume 16 Issue 5 Page 428  - August 2005 

L. Caminiti1, G. Passalacqua2, G. Magazzù3, F. Comisi4, D. Vita1, G. Barberio1, C. Sferlazzas3 and G. B. Pajno1 

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1399-3038.2005.00309.x

Celiac disease (CD) and chronic urticaria (CU) are both sustained by immune mechanisms, but there are so far few data on their clinical association. We performed a casecontrol study to determine the occurrence of CD in urticaria and matched control children, and to assess the clinical relevance of this association. Children and adolescents were diagnosed to have severe chronic idiopathic urticaria in the presence of hives for more than 6 wk poorly or not responsive to oral antihistamines. Other known causes of urticaria had to be excluded. A matched control group without urticaria was enrolled. In both groups, the presence of CD was searched by assaying antitransglutaminase and antiedomysial antibodies, and confirmed with endoscopic intestinal biopsy. Results. CD was diagnosed and confirmed in 4/79 (5.0%) of children with CU and in 17/2545 (0.67%) of the controls (p = 0.0003). In the four children with urticaria and CD the gluten free diet (GFD) lead to complete remission of urticaria within 5-10 wks, whereas the disappearance of serological markers occurred in longer times (5-9 months). Conclusions. The presence of CD in children with CU was significantly more frequent than in controls. GFD resulted in urticaria remission. CD may be regarded in such subjects as a cause of CU.

http://pediatrics.aappublications.org/cgi/content/full/106/5/1139

Most cases of chronic urticaria (CU) are considered idiopathic. It has recently been accepted that autoimmunity plays a critical role in the pathogenesis of CU in some of these patients. Although urticaria is common in the pediatric population, the knowledge regarding CU-associated autoimmunity is very limited.  We describe the association of CU with a wide spectrum of clinical and laboratory autoimmune disorders in 2 children and emphasize the concept that CU is another manifestation of the "autoimmune kaleidoscope."

http://adc.bmjjournals.com/cgi/content/full/88/6/517

Chronic urticaria: association with thyroid autoimmunity Y Levy1, N Segal1, N Weintrob2 and Y L Danon1 

Conclusion: Children with chronic urticaria should be screened periodically for thyroxine, TSH, and antithyroid antibodies, as thyroid autoimmunity and hypothyroidism may appear several years after onset of the urticaria.

and Reply Archives of Disease in Childhood 2004;89:293:

LETTER  Chronic urticaria and coeliac disease R Meneghetti, T Gerarduzzi, E Barbi and A Ventura Istituto per l'Infanzia Burlo Garofalo, Trieste, Italy

"We appreciated the paper by Levy et al published in this journal in June 2003.1 

A number of the cases of chronic urticaria in children appear to be of unknown aetiology, and experiences such as the one reported by the authors indicate an autoimmune origin. In our opinion the model of association between thyroiditis and chronic urticaria may apply to the association between coeliac disease and chronic urticaria as well. .Therefore, even if this association is rare, we think that it is important to extend the field of investigation in the area of autoimmunity, screening for coeliac disease all subjects affected by chronic urticaria of unknown origin. This recommendation is strengthened by the consideration that the diet for coeliac disease could help their urticaria to improve, and may prevent the development of other types of autoimmune disorders." 

Dermatitis herpetiformis presenting as chronic urticaria. 

Pediatr Dermatol. 2004 Sep-Oct;21(5):564-7 Powell GR, Bruckner AL, Weston WL. Department of Dermatology, University of Colorado Health Sciences Center, Aurora, Colorado.

Childhood dermatitis herpetiformis (DH) is an immunobullous disease  associated with gluten-sensitive enteropathy. This disease is rare in  children and is typically characterized by intensely pruritic vesicles on the extensor surfaces. Definitive diagnosis of DH depends on the direct immunofluorescence finding of granular or fibrillar IgA deposits along the basement membrane zone of biopsied perilesional skin. We report an 11-year-old boy with an unusual presentation of DH characterized by a 7-month history of chronic urticaria-like skin lesions. He had evanescent, largely asymptomatic, urticarial wheals on his trunk, face, and extremities that were unresponsive to conventional therapy for urticaria. Skin biopsy specimen findings were consistent with DH and direct immunofluorescence of perilesional skin was diagnostic. The patient had no symptoms of gluten-sensitive enteropathy at the time of diagnosis, and his skin lesions rapidly cleared with dapsone therapy. This patient serves to highlight an unusual presentation of childhood DH and the need to consider this diagnosis when evaluating chronic urticarial lesions in children.

Idiopathic chronic urticaria and celiac disease.

Gabrielli M, Candelli M, Cremonini F, Ojetti V, Santarelli L, Nista EC, Nucera E, Schiavino D, Patriarca G, Gasbarrini G, Pola P, Gasbarrini A.

Department of Internal Medicine, Catholic University the Sacred Heart, Rome, Italy, [log in to unmask]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16133973&query_hl=1

Idiopathic chronic urticaria (ICU) is a chronic relapsing cutaneous disease. Some case reports or studies on small series of celiac disease (CD) patients have suggested a possible association between CD and ICU. The aim of this study was to assess the prevalence of CD in a population of adults ICU patients with respect to healthy controls. We consecutively enrolled 80 patients affected by ICU and 264 blood donors as the control population without a history of ICU. Serum anti-transglutaminase IgG and anti-endomysium IgA antibodies were evaluated in all subjects. In the case of positivity to serology, diagnosis was confirmed by duodenal biopsy. One of 80 (1.25%) ICU patients were positive to both anti-transglutaminase and anti-endomysium antibodies. Duodenal biopsy showed partial villous atrophy. One control of 264 (0.38%) had CD. No statistical difference was found in the prevalence of CD between the two groups. ICU patients do not seem to bear a greater risk for CD compared to the general population.

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