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Hives

Pediatric Dermatology Basics

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Updated May 20, 2014

Woman pouring medicine for son
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When a child has hives (also called urticaria), the first thing a parent tries to think of is what has the child recently eaten that could be causing the allergic reaction.

It is important to remember that there are many more things in addition to food allergies that can cause hives in kids. These include medications, infections, exposure to the sun, and for some kids, even physically stroking their skin, which is called dermographism.

What are Hives?

Hives are a sign of an allergic reaction, and are usually harmless if they are the only symptom your child is having. Children with hives and more severe symptoms, such as wheezing, difficulty breathing or swallowing, or swelling in their mouth or throat, may have anaphylaxis - a serious allergic reaction. These children need immediate medical attention.

Hives are a type of allergic or immune system reaction that occurs when something triggers the release of a chemicals, including histamine, from cells in a child's body.

Symptoms of Hives

In addition to their typical appearance as red or pink raised areas on your child's skin, hives are usually:
  • itchy
  • seen alone or are in groups
  • varied in size, with some being smaller than your child's finger tip and other's larger than a half-dollar size. Also, hives can often merge or join to form even larger hives that, for example, can cover half of your child's abdomen.
  • temporary and come and go over several hours. They often don't go away completely though. Instead, old hives go away in one part of your child's body, while new ones continue to appear somewhere else. Any individual hive shouldn't last more than 24 hours. If it does, then your child may have a similar skin rash, such as erythema multiforme, and not simple hives.
Less commonly, hives can sting, be painful, and can leave bruises on your child's skin.

A child with hives may have additional symptoms depending on what is triggering the hives. For example, if a viral infection is causing the hives, then he may have a sore throat, runny nose, and/or cough.

Causes of Hives

Although some things, such as certain foods, commonly cause hives, keep in mind that almost anything can trigger hives.

Common causes of hives can include:

  • foods, especially peanuts, eggs, tree nuts, milk, shellfish, wheat, and soy
  • medications, especially antibiotics like penicillin and sulfa drugs
  • additives in foods or medications, such as the food dye tartrazine (Yellow No. 5)
  • infections, especially viral infections
  • insect bites and stings
  • latex
  • exercise
  • stress
  • exposure to heat, cold, or water, no matter what the temperature is
  • dermographism, a physical urticaria, in which hives are triggered by stroking the skin, such as by scratching
To help figure out what is causing your child's hives, keep a diary of all of your child's medications and everything he has recently had to eat and drink.

Allergy testing is sometimes necessary to figure out what is causing hives, especially if a child's hives are not going away or a child keeps getting hives over and over. Fortunately, most kids don't need testing for their hives, and unless the trigger is obvious, like when it follows eating a peanut butter and jelly sandwich or they are on Amoxil for an ear infection, there is a good chance that they won't have hives again.

Treatments for Hives

Since hives are caused by the chemical histamine, it makes sense that you would treat them with an antihistamine medication, such as diphenhydramine (Benadryl). Other sedating antihistamines that are sometimes used to treat hives include hydroxyzine (Atarax) and cyproheptadine (Periactin).

Non-sedating antihistamines, including Allegra, Claritin, Clarinex, and Zyrtec, are also used to treat hives, expecially hives that last longer than 6 weeks.

Less commonly, a child may need a steroid to treat his episode of hives. Other treatments can sometimes include doxepin (Sinequan), an antidepressant that can work as a potent antihistamine, montelukast (Singulair), and medications such as ranitidine (Zantac) or cimetidine (Tagamet), which are more commonly used to treat reflux.

Of course, the best treatment for hives, whenever possible, is to remove and then avoid whatever is triggering your child's hives.

What You Need To Know About Hives

  • Hives are not considered chronic or long-term until they last for six weeks or longer. Chronic hives are rarely caused by food allergies. In fact, triggers for chronic allergies are only found about 20 percent of the time.

  • If no cause is found for your child's chronic hives, it is usually referred to as idiopathic hives.

  • Individual hives are also called welts (not whelps, a common misspelling for welts) or wheals.

  • It is a common myth about hives that it has to be something 'new' that is causing your child's hives, when it is much more common that your child has had something two, three or more times before it finally triggers hives.

  • Although an allergic reaction to a food is usually fairly quick, and occurs within minutes to hours, it may take days or weeks for an antibiotic to trigger hives in your child.

And keep in mind that a pediatric allergist and/or pediatric dermatologist can often help your pediatrician figure out what is causing your child's hives.



Sources:

Adverse reactions to foods. Nowak-Wegrzyn A - Med Clin North Am - 01-JAN-2006; 90(1): 97-127

Adkinson: Middleton's Allergy: Principles and Practice, 6th ed.,

Behrman: Nelson Textbook of Pediatrics, 17th ed.

Habif: Clinical Dermatology, 4th ed.

Urticaria and angioedema. Baxi S - Immunol Allergy Clin North Am - 01-MAY-2005; 25(2): 353-67

Urticaria: selected highlights and recent advances. Dibbern DA Jr - Med Clin North Am - 01-JAN-2006; 90(1): 187-209

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