Chronic Illness • May 20, 2010

Kids’ Hives | What Causes Them & How to Treat Them

Hives, also known as urticaria, can be acute or chronic. Acute urticaria is a common, allergic skin disorder. It’s characterized by well-circumscribed, localized, or generalized raised pink lesions (wheals or welts) of various sizes. Kids’ hives is usually a very itchy rash. Chronic urticaria is a type of urticaria that recurs or lasts longer than 6 weeks.

Causes of Kids’ Hives:

  • Ingestions (usually of foods like seafood, nuts, eggs, or food additives; also, antibiotics like penicillin and sulfa drugs)
  • Direct contact (plants like Poison Ivy, Poison Oak, Poison Sumac)
  • Injected agents (medicines, blood products, insect bites and stings)
  • Inhalants (pollens, dander, etc.)
  • Infections (viral, such as Hepatitis, some bacterial and parasitic)
  • Physical factors (cold, pressure, sun exposure)
  • Systemic Illness (like malignancy, serum sickness)
  • Associated with anaphylaxis or angioedema
  • Rarely hereditary (cold urticaria)

Symptoms & Course:

  • More than 10% of children get hives.
  • Most children who develop hives get it only once. These hives usually come and go for 3 to 4 days and then resolve.
  • If hives occur around the eyes, lips or genitals, it may cause large swelling. Some young children who become sensitized to insect bites may develop big hives called papular urticaria at the site of the insect bites. These can sometimes last for months.
  • Hives are usually self-limited and benign with a good prognosis. They usually need only symptomatic treatment.
  • Chronic urticaria may persist intermittently for months to years and need further investigation.


  • It is important to watch for any potential life-threatening complications that are rarely associated with urticaria. For example, swelling of the upper airways can be dangerous.
  • Progression to anaphylaxis with wheezing and hypotension may also be life-threatening.

Treatment for Hives:

  • The best drug for hives is an antihistamine. It will not cure the hives but it will reduce the number of hives and the itching. Benadryl, one of the commonly used antihistamines is available over the counter. Give the appropriate weight-based dosage indicated on the bottle every 6 hours. The most common side effect of this drug is drowsiness.
  • Calamine or Caladryl lotion applied to the hives can help relieve itching. Also, cool baths or rubbing ice cubes briefly can help with the itching.
  • Avoidance of the possible trigger is the best approach. For hives triggered by pollen or animal contact, take a cool shower. For localized contact, wash the allergic substance off the skin with soap and water. Small localized hives usually disappear in a few hours and do not need Benadryl.
  • Rarely, for severe urticaria, oral steroids may be prescribed by your doctor.

Seek Immediate Medical Care:

  • For hives or rash that is worsening or spreading.
  • If the rash looks infected.