Hives in children causes and treatment
Pro Research Analysisby 
Searched over 200M research papers
Causes of Hives in Children: Acute and Chronic Urticaria
Hives, also known as urticaria, are itchy, red skin rashes that can sometimes be accompanied by swelling called angioedema. In children, hives are most often acute, meaning they last less than six weeks, while chronic hives (lasting more than six weeks) are less common Poowuttikul2021Novembre2008Shin2017.
Acute Hives in Children: Common Triggers
Acute hives in children are usually triggered by:
- Viral and other infections (the most common cause, especially in infants and young children)
- Allergic reactions to foods or medications
- Contact with chemicals or irritants
- Physical factors like pressure, cold, or heat
In many cases, the exact cause of acute hives cannot be identified and is considered idiopathic Poowuttikul2021Novembre2008Shin2017.
Chronic Hives in Children: Causes and Risk Factors
Chronic hives are less frequent in children and are often idiopathic, meaning no clear cause is found. When a cause is identified, it may include:
- Physical factors (such as pressure, cold, or heat) in about 5-10% of cases
- Infections, foods, food additives, drugs, and aeroallergens
- Autoimmune factors, with about one-third of children having autoantibodies against IgE or its receptor
- Rarely, underlying systemic diseases or hereditary conditions
Parasitic infections are a rare cause in developed countries but may become more relevant with increased immigration from regions where such infections are common Novembre2008Miri2019Shin2017.
Diagnosis of Hives in Children
Diagnosis is mainly based on a detailed medical history and physical examination. Laboratory tests are not routinely needed unless there are signs of chronic or unusual hives, or if urticarial vasculitis (painful, long-lasting lesions with systemic symptoms) is suspected Poowuttikul2021Novembre2008. Universal allergy testing is not recommended for chronic hives, as it rarely identifies the cause and may lead to unnecessary dietary restrictions .
Treatment of Hives in Children
General Management
The main steps in treating hives in children are:
- Identifying and removing the triggering factor, if possible
- Reducing exposure to non-specific factors that may worsen symptoms (like heat or stress)
- Using anti-H1 antihistamines as the first-line treatment
Short courses of steroids may be used if antihistamines are not effective, especially in severe cases. In some cases, anti-H2 antihistamines or leukotriene antagonists may be added, though the benefits are not always clear .
Treatment of Chronic or Severe Hives
For chronic hives that do not respond to standard treatments, options may include:
- Immunosuppressive medications like cyclosporine or tacrolimus in severe, resistant cases
- Integrative therapies, such as traditional Chinese medicine, have shown promise in small case series for children with frequent, persistent, and difficult-to-treat hives, especially those related to food allergies, but more research is needed Novembre2008Xiawen2020.
Emergency Management
If hives are associated with anaphylaxis (severe allergic reaction), immediate treatment with intramuscular epinephrine, antihistamines, steroids, and supportive care (fluids, bronchodilators) is required Novembre2008Xiawen2020.
Conclusion
Hives in children are most often acute and triggered by infections, foods, or medications, while chronic hives are less common and usually have no identifiable cause. Diagnosis relies on a careful history, and treatment focuses on removing triggers and using antihistamines. Most cases resolve with standard therapy, but chronic or severe cases may require additional treatments or specialist care.
Sources and full results
Most relevant research papers on this topic
Urticaria and urticaria related skin condition/disease in children.
Urticaria in children can be caused by physical factors, infections, foods, additives, aeroallergens, and drugs, and can be treated with anti-H1 antihistamines, steroids, and cyclosporine.
Successful management of extremely frequent hives in children with multiple food allergies with integrative traditional Chinese medicine therapy
Traditional Chinese medicine therapy effectively reduced frequent, persistent, and difficult-to-treat hives in three pediatric patients with multiple food allergies.
DOI