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Urticaria in Children: What It Is, Why It Happens, and How to Treat It
  • The appearance of a skin rash is often a cause for concern especially with the rise of measles cases in the country. But red spots can mean a lot of things, including a skin condition called urticaria, or more commonly known as hives.

    What is urticaria?

    Urticaria or hives is a common condition that affects up to 25% percent of kids. It is characterized by red, itchy, and swollen bumps or welts on the skin. It can show up anywhere on the body and is often a result of an allergic reaction from medication or food, but there are cases when the cause is unknown.

    Hives can vary in size from one-half inch to several inches, according to Stanford Children’s Health. It can look like tiny red spots, blotches, or large connected bumps. It can last anywhere from a few hours to a week (or even longer) and change locations on the body, according to KidsHealth. Hives that last six weeks or less are called acute hives, while those that go on longer than six weeks are called chronic hives.

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    What causes urticaria

    Urticaria has a number of triggers, including food and medication.

    Food that commonly causes urticaria

    • Milk
    • Wheat
    • Nuts
    • Eggs
    • Shellfish
    • Berries

    Medication that commonly causes urticaria

    • Antibiotics like penicillin
    • Anticonvulsants
    • Phenobarbital
    • Aspirin
    • Ibuprofen

    Urticaria may also be caused by factors unrelated to allergies, including

    • Extreme cold
    • Sun exposure
    • Exercise
    • Stress or anxiety
    • Insect bites
    • Pets and other animals
    • Viral infections
    • Dermatographism (caused by scratching the skin or wearing tight-fitting clothes that rub the skin)
    • Contact with chemicals
    • Putting pressure on the skin

    Hives that occur due to physical causes (like pressure, sun exposure, or cold) are called physical hives.

    Finding out the cause of chronic urticaria is difficult, and more often than not, doctors have no idea what causes chronic urticaria. Sometimes, it may be linked to an immune system illness like lupus, according to KidsHealth.

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    Signs and symptoms of urticaria

    The red, raised bumps are the main sign of hives. It will typically have a pale center, appear in clusters, change shape and location in a matter of hours, and itch, sting, or cause a burning sensation.

    The bumps happen “when mast cells in the bloodstream release the chemical histamine, which makes tiny blood vessels under the skin leak,” according to KidsHealth. The fluid will pool within the skin and form the spots and welts.

    Sometimes, urticaria is also associated with swelling, known as angioedema, that typically occurs around the eyes, lips, hands, feet, or throat, but can occur anywhere in your child’s body. Other symptoms can include nausea, vomiting, or belly pain.

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    Diagnosing a child with urticaria

    A doctor diagnose urticaria in kids through a simple physical examination or just by looking at the skin. Knowing the child’s medical history, medications, exposure to allergens, and daily stressors can also help diagnose the condition.

    If your doctor suspects your child has chronic hives, he might ask you to keep a daily record of your child’s activities, including what he eats and drinks and where the hives typically show up in the body. Other diagnostic tests like blood and allergy tests, which help rule out other causes of urticaria, might also be ordered.

    “You should also pay attention to any changes to your child’s regular environment that may be contributing to the problem, such as dust, animals, or the outdoors,” said Dr. Bruce Brod, MD, FAAD, a dermatologist at the University of Pennsylvania, in a news release by the American Academy of Dermatology.

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    How to treat urticaria

    In most cases, urticaria will go away on its own. Within a few hours or days of contracting the skin condition, your child should start to look less blotchy or feel less itchy. Avoiding the triggers is the best treatment for hives, according to Stanford Children’s Health.

    Itchy hives may be alleviated with an antihistamine, which will block the release of histamine in the bloodstream and prevent breakouts. Oral steroids may also be given for a brief period to alleviate severe flares of acute and chronic urticari, but doctors may not prescribe it beyond two weeks of use to prevent harmful steroid side effects, according to KidsHealth. Any medication must be prescribed by a doctor.

    When bathing your child, make sure to use lukewarm water and limit the bath to 10 minutes, according to Dr. Brod. Choose a gentle, fragrance-free wash and avoid bubble baths and scented lotions. Pat your child dry and apply a gentle moisturizing cream or lotion on the skin.

    Applying a cool washcloth on the skin may also bring additional relief to your child, says Dr. Brod.

    It’s also important to maintain a comfortable environment for your child. With summer’s increasing temperatures, your child might like staying in an air-conditioned room. Make sure to dress your child in comfortable clothes. Cover the skin to discourage scratching, but use cool fabrics so your child doesn’t feel hot.

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    Is urticaria contagious?

    Unlike measles or chicken pox, urticaria can’t be passed from one person to another. Moms need not worry because they won’t contract hives, even if they touch their child’s skin.


    When should you be worried about urticaria?

    In rare cases, urticaria mixed with angioedema is associated with an allergic reaction that causes anaphylactic shock. When this happens, a child may have trouble breathing and feel like his throat is closing. He might experience a drop in his blood pressure, dizziness, or completely pass out.

    If a child has bad allergies, the doctor may prescribe epinephrine, which decreases swelling and raises blood pressure. Epinephrine is given as an injection and works quickly to reduce allergy symptoms.

    When to see a doctor for urticaria

    Though hives are often harmless and go away on its own, consider going to the doctor when your child experiences the following.

    • Hives last more than six weeks
    • Your child has angioedema and develops shortness of breath
    • Your child has nausea and vomiting
    • Your child is drooling, having trouble swallowing, or is slurring speech
    • The hives were caused by an insect bite, which may require a prescription
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