Figuring out the causes of hives in kids that seem to come out of nowhere can be stressful for parents. Often, they are worried that their child is having a serious allergic reaction. Thankfully, more often than not triggers of hives in children often have a benign cause.
Hives, or urticaria, are a skin reaction that appears as raised, red welts or bumps. They can vary in size and shape, and may appear suddenly or over several days.
In children, hives can appear out of nowhere for a variety of reasons.
Different types of urticaria (hives) in children
There are several different types of hives that can occur in children, including acute urticaria, chronic urticaria, and physical urticaria.
Acute urticaria- acute hives are a short term reaction that is caused by an allergen or infection, typically lasts less than six weeks
Chronic urticaria- chronic hives are a longer lasting condition that can be triggered by an underlying medical condition such as autoimmune conditions or thyroid diseases, often hives will be accompanied by other symptoms such as joint pains
Physical urticaria – this type occurs when the skin comes into contact with a certain stimulus, this can include pressure, cold induced hives, heat, cold water, vibration, exposure to sunlight (solar hives) or physical activity
What do hives look and feel like?
Most often, hives show up as raised and red welts or bumps on the skin. In general, they move around the body. As they disappear in one area, they reappear in a different area of the body. This can go on for several days or weeks depending on the cause.
Kids with urticaria describe a burning or itching sensation from the bumps. Your child may be scratching a lot trying to relieve this itchy rash.
Why do hives form?
Hives are a form of immune system reaction where mast cells release many of their chemical substances into the skin. These chemical messengers cause blood vessels to leak fluid into the surrounding skin and cause these bumps that we call hives.
Mast cells provide a layer of protection against foreign invaders. Their position in the immune system is part of the non-specific arm that forms our initial defense against invading pathogens.
When faced with an allergen, mast cells release substances such as histamine that contribute to an allergic reaction.
Common causes for hives in children
There are many different causes for hives in children that range from allergies and infections to food sensitivities and environmental factors.
Allergies– An allergic reaction can cause an outbreak of hives in some children. Common triggers include foods such as peanuts, tree nuts, milk, eggs, fish and shellfish; medications like antibiotics; bee stings, mosquito bites; latex products; and pollen from trees, grasses and weeds. Food allergies are a common cause of hives in children.
Infections– Viral infections or bacterial infections can trigger an outbreak of hives in some children. Common infections include colds, flu, ear infections and strep throat.
Viral infections are the number one reason for hives that appear out of nowhere in children.
Food Sensitivities or oral allergies– some kids can have a reaction to certain foods that causes redness and hives around their mouth and lips, these are often due to a cross-reactivity with pollens and often cause limited symptoms when a certain food is ingested
Environmental Factors– Exposure to irritants like dust mites or pet dander can cause hives in some kids. Other triggers may include hot temperatures or extreme cold temperatures; exposure to sunlight; physical activity or exertion; stress; emotional upset; insect bites/stings; certain fabrics like wool or polyester; soaps and detergents; perfumes/colognes/body sprays; swimming pool chlorine; certain plants such as poison ivy/oak/sumac and cigarette smoke
Treatment for Hives in Children
Treatment for hives in children depends on the underlying cause. If you suspect an allergic reaction, have your child avoid the allergen and take prescribed antihistamines.
If an infection is suspected, antibiotics may be needed. In some cases, corticosteroids or other medications may be prescribed to reduce inflammation and itching.
For physical urticaria, avoiding contact with the trigger can help prevent future outbreaks. Other treatments may include lubricating creams or lotions to soothe the skin and cool compresses to reduce swelling and itching.
When to call the pediatrician
It is important to know that children who have an initial reaction to a certain food or other allergen may go on to have an anaphylactic reaction with repeated exposure. Anaphylaxis is distinguished from simple hives due to the presence of additional symptoms such as stomach pain or belly pain, vomiting, hoarse voice, trouble breathing and of course loss of consciousness.
After any episode of hives that was caused by food, it is important for your child’s pediatrician to know so that they can possibly prescribe an Epi pen. A shot of epinephrine may be necessary if your child is experiencing anaphylaxis.
In addition to prescribing Epinephrine, your pediatrician will likely refer your child to an allergy specialist for further skin tests and/or other allergy tests.
Children with allergies can often be treated with over-the-counter antihistamines, but your child’s pediatrician or allergist can better direct their medical care based on their symptoms and blood tests or skin tests.
Will my child feel miserable for a long time?
Generally, hives in children typically resolve within a few hours or days, depending on the underlying cause. In the meantime, you can help your child to feel better by treating their symptoms.
Your child may have antihistamines and steroids prescribed to ease their itching. Treating the underlying infection or avoiding the trigger can also help your child to feel better quicker.
What are comfort measures for my child?
There are many things that parents can do to help their children feel more comfortable while they are waiting for the hives to resolve.
Avoid contact with what is triggering your child’s hives
Giving them an over the counter antihistamine medication
Using lotions or creams on the skin to help them to feel better, you can even put it in the refrigerator first if cold is not one of the triggers of their symptoms
Applying cool compresses or taking cool showers to reduce swelling and itching
