Hives (the common term for urticaria), are pink or red itchy rashes that may appear as blotches or raised red lumps (wheals) on the skin. They range from the size of a pinhead to that of a dinner plate. When hives first start to appear, they can be mistaken for mosquito bites as they are itchy.
Swellings usually disappear within minutes however some will stay for an hour or so. In most cases, hives are not due to allergy and they can be effectively treated with a non-drowsy, over the counter antihistamine.
If hives occur most days for more than six weeks, this is defined as chronic (ongoing) urticaria, which may require additional medication.
Top tips
- Hives are common – up to 20 per cent of people develop hives at some time during their life.
- Hives can also cause deeper swellings in the skin and mucosa called angioedema. These swellings are often bigger, last longer, may itch less, sometimes hurt or burn and respond less well to antihistamines. Angioedema most frequently affects the face and lips.
- Although hives and facial swelling can be uncomfortable and cosmetically embarrassing, they are not usually dangerous.
- In most cases, hives are not due to allergy. Contact allergy to plants or animals can also cause hives.
- 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 can make the symptoms worse.
Daniels Story with Chronic urticaria (CU)
Daniel first began to get an occasional small symptom from the age of three. By age 6, he was severe with multiple breakouts a day requiring a referral to a clinical immunologist, allergist. Sadly pin prick tests could not be completed on the day as stress also caused Daniels' hives to erupt so he has too many hives at the time of testing for there to be an accurate result. It was decided that Daniel be placed on an intensive 6 month intensive Zyrtec trial. The results of this trial was that Daniel may have hives for a minimum of ten years or perhaps forever.I did not worry to much about this as it did not seem to worry my easy going son too much. He has daily antihistamine and the odd trip to the school nurse (especially on hot days for an ice pack).
We did eventually get that pin prick test though and discovered that Daniel is allergic to dust and most grass and we already knew that he was allergic to lactose and soy. Although he tested negative to dog allergies, he does tend to break out in hives when he plays with our two dogs but he does not mind.
Unlike CU in adults, in children this is rarely associated with autoimmune diseases and blood testing is not indicated in most cases. As Daniel ages though, we will test his thyroid as his Mother has Hashimotos disease.
Treatment
- Avoid aggravating factors if identified – for example, the cold and excessive heat.
- Medications can help.
- Second generation antihistamines (desloratidine, cetirizine, loratadine and fexofenadine) can be given regularly if hives occur daily. It may be necessary to increase the daily dose for refractory rash under the supervision of your doctor as Daniel did.
- Diets – there is no evidence to suggest special diets have a role in managing children with acute or chronic urticaria
Prognosis
There is rarely any risk of a severe episode involving the breathing or circulation (anaphylaxis).If it’s not an emergency but you have any concerns, and you are in Australia then contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it.In an emergency, always contact 000 for immediate assistance.