“I’m Only Human” #004: Urticaria

In the photo: Urticarial rash in a school age child recently treated by Little Spuds Pediatrics.

Parents often worry when their child gets hives, as hives can indicate a serious condition called anaphylaxis. Parents should know however, that hives can also result from less serious causes and usually go away on their own with simple home care. In this 4th edition of our educational series "I’m Only Human," we share helpful information about hives and what it can mean for your child’s health.

Urticaria Quick Facts

• Urticaria, or hives, is a common raised, welt-like rash occurring in infants, children. Hives can happen from an allergy, a medication, an infection, or physical exposures.

• Hives can look like a few raised bumps or larger round welts over the entire body.

• Hives typically come and go and resolve with time.

• Hives can be categorized as “acute” when they last less than 6 weeks and “chronic” when they last more than 6 weeks.

• Most often hives are very itchy. Over the counter antihistamines, such as cetirizine, are often used to reduce the uncomfortable itching that is typically worse at night.

• Sometimes hives occur with a condition called “angioedema” where the lips, face, eyelids, ears, mouth, hands, feet, or genitals can become puffy or swollen.

• Angioedema with hives can be a sign that a child is having a serious life threatening allergic reaction called anaphylaxis and requires immediate emergency care.

Causes

Hives usually indicate that the immune system has reacted to something eaten or something the body contacts. Hives can be caused by allergies or other factors. Allergic causes include food, medications, and insect stings or bites. Non-allergic causes can be infections, medications, or physical triggers.

Allergic

A severe allergic reaction is also called anaphylaxis. Severe allergic reactions happen quickly, usually within minutes to 2 hours after exposure and require immediate care in an emergency room. Common causes include foods, medications, latex, and insect stings or bites. After a child first comes into contact with an allergen, further exposures can lead to more severe reactions, so it's crucial to identify and avoid the trigger promptly.

SYMPTOMS

Children with hives from a severe allergic reaction may also display other signs, including:

• Lip, face & tongue swelling

• Itching and tingling of the skin, mouth, throat & lips

• Red, swollen eyes

• Difficulty breathing, wheezing, runny nose and sneezing

• Difficulty swallowing with a sensation that the throat is closing

• Vomiting and diarrhea with abdominal pain

• Pale appearance, sweaty, feeling faint

• Feeling anxious, dizzy, confused or irritable

CAUSES

1. Food is a main cause of severe allergic reactions. Foods that commonly cause allergies include:

• peanuts

• tree nuts

• milk

• eggs

• sesame seeds

• fish

• shellfish

2. Antibiotics like penicillin and amoxicillin commonly cause medication related severe allergic reactions.

3. Latex allergy happens in people who are sensitive to natural rubber latex found in items like balloons, erasers, gloves, and some adhesives. The allergic reaction to latex in susceptible people can range from mild to life threatening.

4. Certain stinging insects can cause anaphylaxis in susceptible people. These insects include bees, yellow jackets, hornets, wasps and some ants.

Infectious

Hives are often caused by infections from viruses, bacteria, or parasites, with viruses and bacteria being the most frequent culprits. These hives are typically not related to serious allergic reactions.

Medications

Some medications can cause temporary non-allergic hives. Some of these medications include opioids, such as morphine, dextromethorphan which is commonly found in cough medications, and non-steroidal anti-inflammatory medications, like ibuprofen.

Physical

Physical triggers that less commonly cause non-allergic hives include: exposure to cold or hot temperature extremes, exercise, exposures to some types of plants, and sunlight.

Treatment

• Hives without severe allergic reactions:

  • Usually go away on their own in a few days to a few weeks.

  • Itching can be treated with over-the-counter antihistamines like cetirizine, and sometimes with topical or oral steroids if severe.

• Hives with severe allergic reactions, or anaphylaxis:

  • need immediate treatment in an emergency room to avoid airway obstruction and other serious conditions, including death.

  • once discharged from the emergency room, the child’s primary care provider can place a referral to an allergist to try to identify the allergen. Once identified, the child should avoid future contact or ingestion with that allergen to prevent further serious allergic reactions.

  • an epi-pen should be prescribed and the child should carry it with them at all times to self-administer if anaphylaxis occurs.

When to See a Provider

• When a child has a urticaria, or hives, they should be evaluated by a pediatric provider to rule out serious causes.

• If the urticarial rash occurs alongside symptoms consistent with anaphylaxis, a child should be evaluated in the nearest emergency department.

Questions? Send us a message HERE.

Little Spuds Pediatrics can quickly evaluate and treat your child for non-emergency, urgent care conditions within the comfort of your home. Not sure if your child needs an in-home visit? Book a telehealth visit to start and if a home visit is needed, the telehealth visit cost counts towards the in-home visit. Book your child’s visit during our regular business hours by clicking HERE.

***The contents of this post, including graphics and written narrative, are intended for educational purposes only. Not to be used as direct medical advice.***