Urticaria
Introduction
Urticaria (er-tuh-care-ia), also called “hives” or “wheals” is a common skin condition that causes the skin to become red, swollen and itchy. It can happen anywhere on the body. Some children may also get deeper swelling in the skin called angioedema which can be seen on their lips and face. Very rarely the allergic reaction can lead to more serious complication known as anaphylaxis where the child may experience difficulty breathing, swallowing, talking and chest tightness.
For most children, urticaria lasts only for a few hours to a few days, for some, it can come and go over weeks to months.
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Teenager with urticaria with hives and wheals covering side of face and neck
Who gets it?
Anyone can have urticaria. Up to 1 in 5 people will experience it at least once in their lifetime. It is very common in children. Both boys and girls are equally affected. Children with eczema, asthma or hayfever have a higher chance of developing uriticaria than those without these conditions.
What causes it?
When your child has urticaria, their body is actually having an allergic reaction to something. Your child's skin releases chemicals making their skin red, itchy and swollen. There are many different causes of urticaria and in many cases a clear cause is often not found. The most common causes are:
Viral infections (for example colds and the flu) - but in most children the infection is not even detectable with any noticeable symptoms
Bacterial infections
Certain foods
Certain medications or vaccines
Latex
Insect bites or stings
Exposure to extremes of temperatures
Scratching the skin
What does it look and feel like?
Looks like…
Urticaria can be any size and shape, but they are usually round red, raised welts that are a few 1-2 centimeters.
It can happen anywhere on your child's skin, but the most important thing is that it can show up in different places at different times of the day.
Some children may get a deeper swelling called angioedema on their lips and face which causes the face or lips to swell up.
Scratching can cause raised lines on your child's skin which is known as dermatographism.
Feels like…
Your child may feel very hot and itchy
Sometimes, instead of itch, your child may complain of stinging
Difficulty with breathing, swallowing or talking can be a sign of a more serious condition called anaphylaxis. Fortunately, most children with uritcaria will not develop this complication.
What tests might be needed?
Generally, no tests are needed for urticaria. A dermatologist will ask you some questions about your child and family, and perform a skin exam where they take a closer look at and feel the skin. They may mark your child's skin to determine if their skin raises into a welt. This is to check for dermatographism, which is a sign of uritcaria.
Rarely, the doctor may order a skin test to rule out food or medication allergies (this is not a common cause). If your child's urticaria lasts longer than normal, your doctor may perform some blood tests or other skin tests to find out the cause and to exclude more serious causes of urticaria. In most cases, no cause is found.
What treatments are available?
What can I do?
Over the counter anti-histamines can be very effective in reducing the itch associated with urticaria for most children. They are very safe medications and can be used long term. Often more regular dosing (than what is routinely recommended) is required to help prevent the rash.
Moisturising regularly, keeping your child cool with fans and ice packs sometimes can help reduce itch.
It is very important to keep an eye on your child and seek medical attention if they have any trouble breathing/ swallowing or talking.
Avoid giving any aspirin or anti-inflammatory medications to your child, they may make the skin worse.
Medical therapies
There are many effective medications available for urticaria which help reduce your child's allergic response. If the symptoms are long lasting or severe enough, your doctor may prescribe one of these medications.
Steroids: steroids by mouth are effective in severe cases and can be given for few days at a time.
Immune medications: Severe, chronic urticaria (which lasts more than 6 weeks) sometimes requires a trial of medications which reduce inflammation, often called immunosuppressive medications.
What happens after treatment?
If you know what may be triggering your child's urticaria, it is best to avoid this trigger in the future so that the urticaria can be avoided.
There are no long-lasting effects of urticaria.
What support is available?
If you have any concerns or any questions, please see your family doctor or dermatologist for support and information.
Authors/Reviewers:
Author: Dr Kevin Lam
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
