Hives in Children: Causes and Treatment

Hives is a common skin condition in children. It is characterized by itchy, raised, red and white welts on the skin. The condition is also medically known as urticaria. Hives are not contagious and may last for a few hours or days. However, in some cases, they may last for a few weeks.

In this condition, histamine is released in response to any external irritants or allergies. Hives are caused by various reasons and can be treated by home remedies. However, you need to consult a doctor if you continually experience hives. 

Common Causes of Hives

Hives in children occur when their immune system senses the presence of any type of allergen in the body. To fight allergens, a child’s immune system sends out histamine into the bloodstream. The role of histamine is to eliminate the allergen from the child’s body. This process causes raised, swollen, and itchy welts on the child’s skin.

There are numerous causes of hives in children. They include but not limited to:

• Pollen
• Bug bites or stings
• Animal dander
• Food allergies
• Exposure to the sun, heat, or cold
• Soaps and detergents
• Certain medications
• Fever
• Illness
• Infections
• Chemical contact

1. Illness

The most common cause of hives is an illness. Usually, illnesses are caused by viruses but there can also be many other causes. If your child has no fever or symptoms of illness, then hives may not be due to an illness. If there are no other symptoms other than fever, then it might be due to a harmless virus. 

2. Infections

Infections in children also cause hives. They include:

• Sinus infections
• Strep throat
• Infectious mononucleosis
• Urinary tract infection (UTI)
• Bronchitis
• Common cold
• Hepatitis
• Viral infections

3. Foods

Hives can also be caused by the consumption of certain foods such as nuts, eggs, or shellfish. If your child gets hives, think about new foods that were eaten by your child in the past 24 hours.

4. Medications

Hives can be potentially caused by certain medications. Think about the medications given to your child in the past 24 hours. The most common culprit is antibiotics. Other medications that may cause hives include codeine, aspirin, and morphine. The release of histamine in the body can be triggered by these medications.

Sometimes, it is often difficult to tell whether illness or medicine has caused hives. However, you can ask yourself the following questions:

• Are there medications given to your child?
• Have you been using medicine for colds, fever, or pain? 

5. External Irritants

Each day, children come into contact with a variety of substances, which they can be allergic to such as:

• A new shampoo
• Soap
• Fabric softener
• Laundry detergent
• New clothes
• Blankets
• Lotion or suntan
• Bed sheets
• Playing in the bushes or grass

Think about anything that your child’s skin must have come into contact with. Hives in children can be caused by nearly any common environmental allergen. Some children during their early years have sensitive skin. They easily react to certain personal care products, detergents, or fragrance and develop hives. The source of recurrent hives can be identified through allergy testing or by eliminating potential triggers.

6. Nonallergic Hives

Certain agents may be mistakenly regarded as allergens since the immune system of the child is still maturing. In an attempt to fight off allergens, the body releases histamine. The release of histamine happens with or without allergens. Nonallergic hives include heat or cold exposure, sun exposure, and other illnesses.

7. Medical Conditions

Certain medical conditions can cause chronic hives. They include diseases of the liver, thyroid, and kidney. Autoimmune diseases, metabolic disorders, and infectious diseases can also cause hives.

You can keep a record of what your children consume, the activities they do, and the medications they are taking. Your notes can be helpful if one of your children develop a subsequent case of hives.

You can take note of any suspected triggers to help you identify potential triggers in the future. In the case of chronic hives, consult a pediatrician to determine if your child has an underlying medical condition.

Causes of Widespread Hives

• Viral Infection - Children with hives all over the body is usually caused by viral infections, which may last for three days. Aside from hives, other symptoms of a viral infection include cough, fever, or diarrhea. 

• Bacterial Infection - Hives may be caused by bacterial infections such as Streptococcal infections. Hives may also be experienced by individuals who have a bladder infection.

• Drug Reactions - A penicillin rash is an example. When the antibiotic is taken, rashes start as viral rashes. Around 90 percent of allergy tests are usually normal and only 10 percent of it are caused by drug allergies.

• Food Reactions - They may be caused by food allergies. An allergist should be consulted if your child has an increased risk of peanut allergy. Food allergies usually resolve within six days. Around 3 percent of hives are caused by food allergies.

• Bee Sting - After a bee sting, widespread hives may occur due to a serious allergic reaction. An allergist should be consulted in such cases. 

• Anaphylactic Reactions - They are sudden and potentially life-threatening allergic reactions. Along with hives, an individual experiences trouble swallowing and difficulty breathing due to a severe allergic reaction to a specific food or drug. Severe reactions usually show within two hours of exposure to the substance and within 30 minutes of swallowing food or drugs.

• Unknown - Around 30 percent of hives have unknown causes. 

Localized Hives

• Irritants - They are not usually a form of allergy. Developing hives in just one spot can be due to skin contact with certain irritants. 

• Plants - There are certain plants that can cause skin reactions. One example would be an evergreen sap, which causes local hives.

• Pet Saliva - Some people develop skin reactions or hives when they are licked by pet dogs or cats. 

• Pollen - While playing, children can expose their skin to grass and develop hives. 

• Food - Babies may develop hives around their mouth due to drooling from new foods. When certain foods are rubbed on a child's skin, it may cause a skin reaction that leads to hives. 

• Bee Sting - A bee's venom can cause a skin reaction that can lead to the development of hives. 

• Insect Bite - Reaction to the insect's saliva can cause local hives. 

Treatment

It is recommended to see a doctor to properly diagnose and help identify the root cause of hives.

1. Learn About Hives

Hives can either be localized or widespread. It is possible to identify the cause of hives by learning the presentation of hives:

• Localized Hives - Usually caused by direct skin contact with pollen, plants, chemicals, etc. and often appear on one part of the body.

• Widespread Hives - Tend to affect the whole body and may occur due to allergic reactions or infections. 

2. Know the Causes of Hives

It is possible to effectively treat hives at home. You can also consult your child's pediatrician to know the cause of hives whether they are localized or widespread.

Most of the time, hives are caused by the ingestion of certain food items. It usually goes away within six hours. Certain medications, exposure to pollen, stress, or anxiety may also cause hives. Other causes of hives are viral or bacterial infections, contact with certain chemicals, and exposure to extreme temperature.

3. See a Pediatrician

Visit your child's pediatrician if:

• Your child has hives and you are unsure of the cause
• You recently started a new food or medication
• The hives do not disappear within a week
• Your child feels uncomfortable 
• Your child has been stung by an insect

Oral medications, steroids, and creams are usually prescribed by the doctor. If you are unsure of the cause, see a doctor instead of treating the condition on your own to avoid worsening your child's condition. Seek immediate medical help if your child's hives are severe and you don't see any improvements after two doses of antihistamines.

Rush to the nearest emergency room if your child shows signs and symptoms of anaphylactic shock such as swelling of the face and throat, trouble breathing, feeling faint, or wheezing.

4. Medical Tests

To identify the cause of hives, the doctor may recommend blood tests. To identify the specific allergen, the doctor may recommend an allergy test.

5. Treat the Underlying Condition

If the hives are caused by an underlying condition, then the doctor may treat it first. Treating the root cause of hives is more effective than treating the symptoms of hives. 

6. Avoid Triggers that Cause Hives

Hives can be prevented by avoiding known irritants or triggers, which include environmental factors, medications, soaps, detergents, or extreme temperature. Use soaps and detergents that are mild or hypoallergenic for your child’s sensitive skin.

Medications

• Antihistamines - Histamine that causes an allergic reaction can be blocked by antihistamine medications. They relieve inflammation and skin itching. Few of the most commonly prescribed antihistamines include diphenhydramine, cetirizine, and chlorpheniramine. While on these drugs, be cautious with your child’s safety since antihistamines have a sedative effect.

• Histamine 2 (H2) blockers - They include Zantac (ranitidine), Pepcid (famotidine), Tagamet (cimetidine), or Axid (nizatidine). The associated side effects of these drugs include headaches and digestive problems.

• Corticosteroids - The doctor may prescribe either an oral corticosteroid or stronger topical medications. However, these drugs should only be used for a short period of time since their long-term use may cause serious side effects. 

• Allergy Injections for Asthma - Hives can also be relieved by allergy shots for asthma such as omalizumab. There are no side effects associated with it.

• Asthma and Allergy Medications - Asthma drugs such as Singulair (montelukast) or Accolate (zafirlukast) along with over-the-counter antihistamines can be prescribed. Mood or behavior changes may be observed due to these medications.

• Immunosuppressant Drugs - The response of the immune system to hives can be eliminated by cyclosporine. The associated side effects of these drugs include nausea, headache, and reduced kidney function. Immune system reactions can also be suppressed by tacrolimus. The side effects of tacrolimus are similar to cyclosporine. Another immune system suppressor is mycophenolate. 

Home Remedies

• For Localized Hives - Wash off the allergen with soap and water. It will prevent hives from becoming worse.

• Cool Bath - Prepare a cool bath to reduce itching and redness. The child’s skin can be relieved by sprinkling baking soda or colloidal oatmeal into the bath water. Let your child remain in the bathtub for 10-15 minutes. A cool bath will decrease inflammation and soothe irritated skin. 

• Anti-itch Cream or Calamine Lotion - They help relieve inflammation, itching, and hives. Itching can be relieved by 1 percent hydrocortisone cream. Apply the cream to the affected area once a day after taking a bath.

• Cold Compress - Histamine in the bloodstream can cause itching and inflammation. It can be relieved by applying cold packs. Apply cold compress on the rash for 10-15 minutes every two hours or as needed.

• Avoid Scratching - As much as possible, avoid scratching. If the affected area is scratched, then it can worsen the symptoms and spread the allergic reaction as well as cause skin infections.

• Protect Your Child’s Skin - Your child's clothing should be loose and smooth-textured. This will prevent excessive sweating and also keep your child from scratching. Let your child wear long pants and clothes that are long-sleeved. This will prevent exposure to external irritants. Apply repellents to areas that do not have hives to prevent exposure to insects and further allergic reactions. 

Is Hives Preventable?

The answer would be “yes” and “no”. If you are certain of the root cause of your child’s hives, then you can prevent it by avoiding what triggers it. If hives are triggered when your child is nervous, then relaxation through breathing techniques may help. However, if you don’t know what exactly causes your child’s hives, then it may be tough to prevent its occurrence.

Some children develop hives when they get viral infections such as gastroenteritis or a bad cold. For this reason, it is quite important to practice good handwashing habits to avoid contracting or spreading harmful microorganisms.

Fortunately, most cases of hives in children are not usually serious. They may even grow out of them.