Urticaria (or hives) are common in children, with a lifetime prevalence of about 20 percent. However, since they cause itching and swelling and can make children uncomfortable, parents frequently seek medical advice. Antihistamines and topical steroids are treatments likely available at home. However, when hives persist, it is understandable that parents want to find out the cause.
Common causes, or etiologies, of urticaria include infections, medications, food, insect stings or bites, and other triggers. Frequently, especially in children, no cause of hives is identified. Both viral and bacterial infections may trigger urticaria, and an underlying infection is the cause of most hives in children. Sometimes the triggering illness can be very mild. When patients are referred to an allergist for evaluation, a detailed history is important. We want to review all possible triggers in order to determine appropriate testing and treatments.
Acute urticaria refers to hives that have been present for less than six weeks. Hives of this nature typically resolve with antihistamines and do not return. In cases of hives lasting for one day or episode, it is usually not necessary to do allergy testing if there is no known trigger. Antihistamines are the first line of treatment, and you can use topical steroids as needed. Unless the child is having daily episodes or more severe episodes with other swelling or additional symptoms present, a visit to the allergist is not necessary.
Chronic urticaria includes hives that have been present for six weeks or longer. These episodes typically occur intermittently and may last for months to years. A child with chronic urticaria should be referred to an allergist for further workup. Typically, we recommend daily antihistamines if hives occur more than twice weekly. We may do additional workup for patients with chronic urticaria to make sure there is no underlying condition, such as autoimmune urticaria, which may have additional treatment options.