Hives in kids
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Understanding Hives in Children
Acute and Chronic Urticaria in Children
Acute Urticaria: Urticaria, commonly known as hives, is a pruritic (itchy) and erythematous (red) skin rash that can occur in children. Acute urticaria is relatively common in children and is often triggered by identifiable causes such as infections, medications, or foods. A thorough medical history is crucial in identifying these triggers, and laboratory evaluations may be necessary to confirm the etiology1.
Chronic Urticaria: Chronic urticaria, defined as hives lasting more than six weeks, is rare in children. Unlike acute urticaria, the cause of chronic urticaria is often idiopathic, meaning it has no identifiable cause. Universal allergy testing for food allergens or aeroallergens is generally not recommended in chronic cases as it can lead to false positives and unnecessary dietary restrictions1 3.
Diagnostic Approach and Management
Identifying Causes: For acute urticaria, a detailed medical history can often reveal the cause. In contrast, chronic urticaria's etiology is identified in only a minority of cases. Infections, drug and food allergies, physical urticaria (caused by heat or cold), autoimmune diseases, and dermatographism are potential causes to consider3.
Laboratory Testing: In cases where the cause is not apparent, laboratory tests such as a complete blood count, erythrocyte sedimentation rate, liver function tests, and thyroid studies can be useful. However, food-specific immunoglobulin G tests are not recommended as they do not aid in the clinical diagnosis and only add to the cost3.
Treatment: Antihistamines are the primary treatment for urticaria. Long-acting antihistamines can provide 24-hour relief, while short-acting antihistamines can be used for acute flare-ups. If antihistamines are ineffective or if the hives interfere with the child's quality of life or sleep, referral to a specialist is recommended3.
Special Considerations
Angioedema: Angioedema, which often accompanies urticaria, involves deeper swelling of the skin and mucous membranes. It can be particularly distressing when it affects the face or hands1 3.
Urticarial Vasculitis: This condition should be considered if the hives are painful, last more than 48 hours, leave scars or hyperpigmentation, or are associated with systemic symptoms such as fever, weight loss, and arthritis. A skin biopsy may be necessary for diagnosis1.
Conclusion
Hives in children can range from acute, often easily identifiable and treatable, to chronic, which is more challenging to diagnose and manage. A thorough medical history and appropriate use of laboratory tests are essential in identifying the cause of acute urticaria. Chronic urticaria often requires a more nuanced approach, including the use of antihistamines and specialist referrals when necessary. Understanding these distinctions and management strategies can significantly improve the quality of life for affected children and their families.
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Most relevant research papers on this topic
Approach to Children with Hives.
Urticaria in children is often caused by a medical history and laboratory evaluation, but chronic urticaria is often idiopathic and should be considered for urticarial vasculitis.
HIV Encephalopathy (HIVE) in Children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria
The prevalence of HIV encephalopathy in children at the University of Port Harcourt Teaching Hospital is high, with tuberculosis as the most common comorbidity.
Observational StudyJudicious Allergy Testing Can Aid Allergic Rhinitis Diagnosis
Judicious allergy testing can aid in diagnosing persistent hives in children, but food-specific immunoglobulin G testing is not necessary for diagnosis.
IDDF2020-ABS-0112 Gut-skin axis: decoding the link between the gut microbiome and hives
Chronic urticaria patients have a decreased abundance of certain gut bacteria, potentially leading to inflammatory skin diseases.
Systematic Review
Rigorous JournalUrticaria 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.
An unusual etiology of urticaria.
Orthodontic bands applied to the patient's teeth may cause urticaria, a rare but potentially life-threatening allergic reaction.
Case Report"AM I ALLERGIC TO THE OCEAN?": HIVES IN A YOUNG VACATIONING GIRL
This pediatric case highlights the uniqueness of SDAU in developing urticaria and follicular lesions in an atypical distribution, including the chest and legs, after exposure to salinated water.
Case ReportUrticaria and urticaria related skin condition/disease in children.
Urticaria in children can be effectively treated with identification of triggers, antihistamines, and steroid injections, and cyclosporine and tacrolimus for resistant cases.
HIV Encephalopathy in ART-Naïve, Hospitalized Infants in Mozambique.
HIVE prevalence is high in ART-nave hospitalized infants, particularly in those with risk factors for in-utero transmission.
Observational StudyRigorous Journal