When Should I Bring My Child To A Healthcare Provider For Hives
A single episode of hives without severe symptoms or discomfort doesn’t need medical attention. If your child is uncomfortable, can’t sleep or hives cover a large area of their body, contact their healthcare provider. If theres a trigger or cause of the hives, talk to your healthcare provider to determine if you should avoid it or if further testing is needed.
If your child has signs of anaphylaxis, call for an ambulance right away. Don’t attempt to drive to the hospital.
Chronic hives require medical attention. Allergy testing or other assessments may be necessary to determine the cause. And your child may need a combination of antihistamines to treat them.
A note from Cleveland Clinic
Urticaria in children is common and can have many causes. The appearance of hives may concern you, but they often don’t cause symptoms. Children with mild symptoms may feel better with the help of antihistamines. Some cases last several weeks and require medical attention and possibly additional testing. In rare instances, hives cause a life-threatening allergic reaction. Nearly all children with hives make a full recovery and have no scars.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2022.
References
Hives Are Rarely Due To A Serious Underlying Disease
Whilst a clear cause of hives in not obvious in many cases, causes may include:
- Infection from a virus is the most common cause of hives in children, especially if they last for more than 24 hours.
- Contact allergy to plants or animals may cause localized hives.
- Allergic reactions to food, medicines or insect stings can appear as hives. They usually occur within one to two hours of exposure and disappear in most cases within six to eight hours.
An allergic cause for hives should be suspected if episodes are rare, short-lived and occur under specific circumstances, for example:
- Only when exercising.
- Always within two hours of a meal.
- When symptoms involving other organs occur around the same time, such as stomach pain, vomiting, difficulty breathing or dizziness.
- If hives occur with swelling of the tongue or throat, difficulty breathing or low blood pressure, anaphylaxis should be suspected. Urgent administration of adrenaline and medical assessment is required. Information about anaphylaxis is available on the ASCIA website.
Ongoing hives lasting days at a time are almost never allergic in origin, with the exception of some cases of allergy to medicines. Stress is a very rarely the cause of hives but may make the symptoms worse.
In some people hives are caused by physical triggers, including cold , heat, sunlight , vibration, rubbing or scratching of the skin , and delayed pressure , stress, alcohol, spicy food or coffee may cause symptoms.
How To Know Its Hives And Not One Of These Other Skin Problems
To the untrained eye, hives can have a similar appearance to other common skin conditions, Dr. Choudhury says. He says one way to tell the difference is by how quickly the welts clear up.
Hives will usually have an area of skin that welts up, goes away in a few hours, and then reappears somewhere else, he says. Other skin issues that are often mistaken for hives tend to last for more than one day in the same location, he explains.
Also, check out the welts up close. If the welts are filled with clear fluid, pus, or are brownish in color, it is likely not hives, says Dr. Palep.
Hives are often mistaken for the following skin issues:
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Urticaria Related To Histamine
Approximately 50% of adults and children with chronic urticaria have histamine-releasing autoantibodies. These are IgG autoantibodies directed against the subunit of the IgE receptor on mast cells or, more rarely, against IgE bound to mast cells . These autoantibodies cause mast cell degranulation via activation of the classical complement pathway . They may be demonstrable by the autologous serum skin test , in which intradermal injection of autologous serum causes a weal and flare response however, the ASST is not performed routinely in clinic and clinically, therefore, these patients are very often classified as having idiopathic urticaria. Patients with autoimmune urticaria frequently have associated angioedema and the urticaria tends to run a more chronic course.
Hives That Wont Go Away: The Basics Of Ciu
Hives, those annoying itchy red bumps, often occur with an allergic reaction or sometimes a viral infection. Or sometimes, they can be more serious when they happen with a severe allergic reaction called anaphylaxis.
Most of the time, you can find what caused them. But what if you cant?
There is a condition called chronic idiopathic urticaria . Simply put, it means hives that stick around for more than six weeks for no known reason. Many people call it CIU. About 1.5 million people in the U.S. have it.
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Chronic Urticaria Is Defined When Hives Occur Most Days For More Than Six Weeks
Symptoms of chronic urticaria usually resolve, although this can take months or several years. Most people with chronic urticaria manage with appropriate doses of non-drowsy antihistamines. People with severe symptoms interfering with quality of life may be referred to a clinical immunology/allergy specialist or dermatologist for assessment and consideration of additional medications.
So How Long Do Hives Last
Individual welts, or hives, usually go away in less than one day. However, as the American Academy of Dermatology explains, new hives may appear to take the place of those that disappear, so you may end up suffering from a case of hives for days or even weeks.
Acute hives Most cases of hives last no longer than six weeks. This is known as acute hives. Acute hives often occur as a result of an allergic reaction to something, like food or medication, though they can be caused by other things, as well. If youre not sure whats causing your hives, see your doctor. If you have trouble breathing or swallowing when you have hives, you should go to the nearest emergency room or call 911 right away.
Chronic hives Less commonly, hives last longer than six weeks, sometimes much longer. This is known as chronic hives. Chronic hives are sometimes caused by serious illnesses, so if you experience chronic hives, you need to see a doctor find out whats causing them and discuss the best treatment plan for you.
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Are Any Tests Needed
Usually no tests are needed. The rash is very typical and is easily recognised as hives by doctors. In many cases you will know what caused the rash from the events leading up to it. For example if you have just been put on a new medicine, or if your skin came into contact with a nettle, or if you were stung by a bee.
Mast Cells And Histamines
Underneath the lining of the skin, gut, lungs, nose and eyes are mast cells. These are designed to kill worms and parasites.
Mast cells contain chemicals including histamine. When these are released into the skin in small amounts, they cause itching and irritation. When large amounts are released into the skin, fluid leaks out of blood vessels, resulting in swelling of the skin .
Occasionally, hives produce swelling without an itch.
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What Treatments Help Children With Hives
The treatment thats right for your child depends on the type of hives, symptoms and severity. For acute hives with mild symptoms, treatment might not be necessary.
Children with chronic hives or acute hives and bothersome symptoms may need treatment. Medications like antihistamines can control the itch and slow the spread of hives. Your childs healthcare provider may recommend:
- Cetirizine liquid or tablets.
- Diphenhydramine liquid, capsules or tablets.
- Fexofenadine orally disintegrating tablets.
- Loratadine tablets.
Children with signs of anaphylaxis need emergency treatment to halt the allergic reaction. Care may include an epinephrine injection.
Seeking Emergency Medical Care
Hives can be a sign of anaphylaxis. This is always a medical emergency that needs immediate care. If you have been prescribed an EpiPen for an allergy, use it.
Call 911, especially if youre having trouble breathing. If you dont have an EpiPen, the ambulance will have epinephrine that paramedics can use to provide immediate treatment and will likely reach you much faster than having someone drive you to a hospital. Paramedics can get you to the hospital quickly and monitor your condition the entire time.
Never attempt to drive yourself to the hospital during anaphylaxis. Even if it is a very short drive, its not safe to attempt. You can lose consciousness rapidly.
If possible, after you call 911, keep someone with you until paramedics arrive.
- lightheadedness
If you are experiencing any of these symptoms, call 911.
A doctor may prescribe you an epinephrine injector, such as an EpiPen, for future allergic reactions. Theyll teach you how to use it and answer any questions you might have. Youll keep your epinephrine injector on hand and use it if you develop hives in the future.
Youll still need to visit the emergency room after you use your epinephrine injector, but it can stop anaphylaxis from becoming deadly.
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Patients With Severe Urticaria Unresponsive To Standard Treatments
In a very small number of patients, severe, debilitating urticaria, associated possibly with airway angioedema, bronchospasm and hypotension, persists despite treatment with high-dose H1 anti-histamines H2 anti-histamines and/or LTRA corticosteroids and, perhaps, dietary interventions. These patients usually have autoimmune urticaria and cyclosporin treatment has proved effective in about 65% of such patients in a randomized double-blind study . Longer courses of cyclosporin may give a lengthier clinical response however, the optimum dose and length of treatment have not yet been established. Tacrolimus and mycophenolate mofetil have also been effective in open-label studies. Results of intravenous immunoglobulin treatment in small numbers of patients have been variable . The current recommendation from the clinical guidelines for the use of intravenous immunoglobulin is that intravenous immunoglobulin should not be used unless all other therapies have failed. If patients require immunomodulating therapies, referral to a specialist centre is recommended.
What Do I Do If I Think I Have Ciu
If you think you have CIU, see a board-certified allergist or dermatologist. Both types of specialists treat CIU. They will do a physical exam and ask about your medical history. They may also do allergy testing and blood tests, if necessary.
CIU is not easy to diagnose. To help your doctor decide if you have CIU, use our Hives Conversation Starter with Symptom Tracker.It has helpful questions for you to answer, along with a calendar to track your symptoms.
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How Can You Make Hives Go Away Faster
Hives on Back and Face
In some cases, hives will go away on their own even if you do nothing. However, if youre wondering how long hives will last, its probably because youre pretty uncomfortable, if not downright miserable, and would like them to go away as fast as possible.
There are a number of medications that can be used to treat hives.
Antihistamines These medications, available both over the counter and by prescription, relieve symptoms of allergic reactions, including hives. They are often used to treat acute hives and may also be recommended for long-term use for people with chronic hives. Antihistamines are safe for most people to use, but may cause side effects like sleepiness, dizziness, impaired coordination, and blurred vision.
Steroids Available by prescription, these medications are sometimes used short-term to relieve the swelling, inflammation, and itching associated with hives. Steroids are generally only prescribed if antihistamines alone dont do the job, and only for short periods of times, due to the risk of unwanted side effects such as anxiety, irritability, depression, insomnia, increased appetite, weight gain, headaches, dizziness, nausea, increased sweating, difficulty urinating and increased facial hair in women.
Other anti-inflammatory medications Other medications may also be used to decrease redness and swelling associated with hives.
What Are The Complications Of Hives And Swelling
Anyone who has a severe allergic reaction could have life-threatening swelling of the airways your throat and lungs. This condition is known as anaphylaxis. It can potentially close off the airways, resulting in death.
Anaphylaxis is often triggered by a severe allergic reaction to a certain food, like peanuts and tree nuts, or a bee sting. People having anaphylaxis need an immediate shot of epinephrine, such as injectable epinephrine . Epinephrine opens airways, raises blood pressure and reduces hives and swelling. If epinephrine is used outside of the medical setting, a trip to the ER is warranted, since symptoms can return if epinephrine wears off.
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What Are The Symptoms Of Hives
Hives are characterized by red or pale-colored welts on the skin, which typically come and go throughout the day, says Sourab Choudhury, DO, a dermatologist and the chief medical officer at the Dermatology Specialists, a private dermatology practice in New York City. Sometimes they itch, burn, or sting.
Usually the welts will be surrounded by clear edges. They may look similar to bug bites, but hives generally will appear and disappear more quickly. They may itch, sometimes severely, and theyre not always the same size or shape. They may be as small as the tip of a pen or as large as a dinner plate. When you press the center of a hive bump on the skin, it likely will turn from red to white, which is known as blanching.
Hives may appear on the body grouped together and take over a large area of the skin, or as a couple of individual welts that show up here and there. They can appear anywhere on the body, though some people get them in the same spot over and over again .
Generally, youll know you have hives simply by seeing the hives themselves. If you experience other symptoms, such as swelling in the eyes, lips, or inside of the throat, or if you have trouble breathing, you should call 911 or see a doctor immediately, says Sapna Palep, MD, a dermatologist at Spring Street Dermatology in New York City. These symptoms indicate you may be experiencing a serious allergic reaction called anaphylaxis.
What Are The Types Of Hives And Angioedema
There are different types of hives and angioedema, including:
- Acute: Hives or swelling that last for less than six weeks are considered acute, meaning they come on suddenly. Allergic reactions to certain foods or medications often cause acute hives and swelling.
- Chronic: When hives linger for more than six weeks, the condition is chronic. In 95% of chronic conditions, nobody knows what causes them, though it is thought to be autoimmune in nature.
- Physical: Some people develop hives and swelling in specific situations. Hives might pop up when youre in the cold, heat or sun. Some people react to vibrations or pressure, or exercise and sweating. Physical hives usually appear within an hour after exposure.
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When Should I Call The Doctor
Hives and swelling typically get better without treatment. Call your healthcare provider if you have:
- Hives or swelling that last more than a week.
- Infected-looking bumps .
- Recurring hives that come back every few months.
- Severe itching.
- Signs of anaphylaxis, including wheezing, shortness of breath or vomiting.
- Swollen lips or eyes.
Infection Or Environmental Agent
Hives including chronic spontaneous hives can be a complication and symptom of a parasitic infection, such as blastocystosis and strongyloidiasis among others.
The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called urushiol-induced contact dermatitis. Urushiol is spread by contact but can be washed off with a strong grease- or oil-dissolving detergent and cool water and rubbing ointments.
Dermatographic urticaria is marked by the appearance of weals or welts on the skin as a result of scratching or firm stroking of the skin. Seen in 4â5% of the population, it is one of the most common types of urticaria, in which the skin becomes raised and inflamed when stroked, scratched, rubbed, and sometimes even slapped.
The skin reaction usually becomes evident soon after the scratching and disappears within 30 minutes. Dermatographism is the most common form of a subset of chronic hives, acknowledged as “physical hives”.
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What Causes Urticaria
Urticaria occurs when a trigger causes high levels of histamine and other chemical messengers to be released in the skin. These substances cause the blood vessels in the affected area of skin to open up and become leaky. This extra fluid in the tissues causes swelling and itchiness.
Histamine is released for many reasons, including:
- an allergic reaction like a food allergy or a reaction to an insect bite or sting
- cold or heat exposure
- certain medications like non-steroidal anti-inflammatory drugs or antibiotics
However, in many cases of urticaria, no obvious cause can be found.
Some cases of long-term urticaria may be caused by the immune system mistakenly attacking healthy tissue. However, this is difficult to diagnose and the treatment options are the same.
Certain triggers may also make the symptoms worse. These include:
Read more about the causes of urticaria.
How Do I Manage Hives
Beyond medications, here are some strategies to consider that can help you prevent hives from developing or provide relief.
- Avoid known triggers, including foods.
- Wear loose-fitting, light clothing. Dont wear materials such as wool, which could irritate the skin.
- Avoid scented soaps and laundry detergents.
- Soothe the affected skin with a cool wet cloth, lotion or anti-itch cream.
- Cover itchy areas with bandages to avoid scratching them.
- If you must scratch, try pressing on the itchy area or stroking it using the top side of the hand instead of fingernails.
- Drink water often. Hydration can help the skin.
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