Brief overview
- Causes and risk factors: Mostly infections, intolerances or allergies (e.g. to medications or food or food additives); other possible triggers are skin contact with toxic/irritating substances (e.g. stinging nettle), cold, heat, pressure on the skin, sweat, physical exertion, stress
- Symptoms: Skin redness, itching, wheals, rarely skin/mucous membrane swelling (angioedema).
- Treatment: avoid triggers, cool rash, medications (usually anti-histamines, possibly others such as cortisone)
- Examinations and diagnosis: Medical history and physical examination; sometimes more detailed clarification by blood examination or allergy test; very seldom tissue sample.
- Course of disease and prognosis: Usually good, symptoms usually subside within six weeks. Rarely there is an emergency because the mucous membranes of the respiratory tract swell.
What is hives in children?
Hives is a skin condition that affects both children and adults. Doctors also refer to hives as wheal addiction or urticaria. Urticaria is relatively common, with about one in five people affected by hives at some point in their lives.
Typical of hives in children and babies are the bright red, itchy wheals on the skin. Doctors generally distinguish between two forms of hives in children:
- Chronic urticaria:This form is less common in children and babies and is more likely to occur in adults. Here the causes are usually not in the immune system. The symptoms often persist beyond six weeks.
If it comes to shortness of breath, circulatory weakness or other threatening symptoms, call the emergency doctor immediately (112)!
Is hives contagious in children?
Hives are not contagious. So, children with the rash do not pose any danger to family members and other people around them.
Causes of hives in children
Doctors distinguish two main types of hives in children (and adults):
- spontaneous hives
- and inducible urticaria.
In both cases, the symptoms of hives are caused by the activation of certain immune cells (mast cells) in the skin, which result in the increased release of the neurotransmitter histamine. This causes itching, skin rash and skin/mucous membrane swelling.
Spontaneous hives
It occurs suddenly and without any obvious external trigger. A distinction is made according to the duration of the symptoms:
- Spontaneous acute hives: The symptoms last for a maximum of six weeks. After that, the symptoms disappear again.
Inducible hives
Here, the skin symptoms are triggered by contact with specific stimuli. According to the nature of these stimuli, inducible urticaria is further divided into different forms:
Physical hives.
Sometimes hives in children (and adults) are triggered by physical stimuli. For example, depending on the type of stimulus, there are the following forms of the disease:
- Cold urticaria (cold contact urticaria): the trigger here is skin contact with cold objects, cold air, cold wind, or cold liquids.
- Heat urticaria (heat contact urticaria): Here, a child develops the hives from skin contact with local heat, such as a hot foot bath or blow drying.
- Urticaria factitia (urticarial dermographism): Shearing forces, such as those produced by scratching, scrubbing or rubbing the skin, are the trigger of the hives rash in this case.
- Light urticaria: This is when sunlight or the UV light in a solarium cause the symptoms of urticaria.
Special forms of urticaria
- Cholinergic urticaria: This is triggered by an increase in the core temperature of the body, for example due to a hot bath or spicy food. Physical exertion and stress also sometimes cause cholinergic urticaria when they drive up the temperature inside the body.
- Contact urticaria: Here the skin reacts to contact with so-called urticariogenic substances. Sometimes this is an allergic reaction (e.g. to insect venom, fish, certain fruits, latex, certain medications). It is also possible to have a non-allergic reaction, such as to nettles, jellyfish, strawberries, or Peru balsam (e.g., in wound-healing ointments).
- Aquagenic urticaria: Very rarely, contact with water (e.g., while showering, swimming, or in rainy weather) triggers hives in a child. However, this is not an allergic reaction!
Hives in children: The most common triggers
Most often, hives in children are triggered by an infection. For example, in some cases a flu-like infection, an inflammation of the middle ear or throat causes spontaneous acute urticaria in the child. When the infection subsides, the child’s urticaria usually disappears.
Spontaneous chronic urticaria in children is analogous but rare. Triggers include a chronic persistent infection, for example with streptococci or more rarely with worms or other parasites.
A pseudo-allergic hives rash is usually caused by certain medications or preservatives or dyes in foods.
Other factors that potentially trigger urticaria in children include:
- Physical stimuli such as cold, heat, scratching, pressure, or friction on the skin (e.g., from clothing, school bag)
- Skin contact with irritating or toxic substances (e.g., touching stinging nettles or jellyfish)
- Sweat
- Stress
Often no cause can be found for the itchy wheals and/or skin/mucous membrane swellings. Doctors then speak of idiopathic urticaria.
Sometimes urticaria is not caused by one trigger alone, but by a combination of factors – for example, a viral infection plus antibiotic administration or physical exertion plus consumption of a triggering food.
What does hives look like in children?
Hives, also called urticaria, is the name for a red, itchy skin rash with wheals (raised skin blisters) – like when the skin comes into contact with stinging nettles. (This is where the name of the skin condition comes from.) The wheals with redness all around are sometimes as small as the head of a pin, but can also grow to the size of the palm of your hand.
Hives can occur in children at any age. Boys and girls are affected to the same extent. Children with atopic dermatitis suffer from chronic hives more often than other children.
How is hives treated in children?
Treatment of hives in children (and adults) depends on the form of the disease and its severity. If possible, one tries to avoid or eliminate the trigger or cause of the hives.
In addition or alternatively (if the trigger/cause is not known or cannot be eliminated), treatment aims at symptom freedom: it is important that the child is as symptom-free as possible.
Avoid triggers
If the trigger of your child’s hives is known, it is important to avoid it – if possible.
For example, if your child develops hives from certain food additives (such as dyes or preservatives), it is important to remove these products from the child’s diet if possible.
If certain medications are the trigger of urticaria, the doctor avoids them and replaces them with a better tolerated preparation. Inform the doctor if certain medications are known to trigger hives in your child.
Cold against itching
If your child suffers severely from itching, it is helpful to cool the rash. This can be done, for example, with a cooling pack that you wrap in a thin towel and place on the itchy skin area.
Cooling ointments and creams also often relieve the unpleasant discomfort, so that your child feels more comfortable. Such preparations are available over the counter at pharmacies.
Medication
It is often necessary to treat hives with medication, for example in the case of chronic urticaria or pronounced acute urticaria. Primarily, anti-histamines such as cetirizine are used for this purpose.
These active ingredients block the docking sites of the messenger substance histamine, which is responsible for the development of the skin reactions. The anti-histamines are taken – in what dosage and for how long will be explained to you by the attending physician.
If the treatment with anti-histamines does not work (sufficiently), other drugs are an option. These are, for example, glucocorticoids (“cortisone”), which are given in addition to anti-histamines – as a juice, tablet or suppository.
Such supplementary short-term cortisone treatment is used, for example, in severe acute hives with swelling of the skin/mucous membranes.
A severe episode of chronic urticaria can sometimes only be controlled with cortisone. Because of the possible side effects, however, this is also used only for a short time.
Otherwise, chronic hives that cannot be successfully relieved with anti-histamines alone are often treated with a leukotriene antagonist. These agents are sometimes also used in asthma therapy.
Very rarely, hives in children are so severe that the treating physicians have to resort to other medications – such as the artificially produced antibody omalizumab. It is directed against the antibody immunoglobulin E, which plays a role in many allergic reactions.
Homeopathy for hives
Some parents also want to treat their child’s hives rash in alternative ways. Herbal preparations (such as anti-itch and anti-inflammatory ready-to-use preparations based on the ancient medicinal and poisonous plant bittersweet nightshade) are used for this purpose, among others.
Some parents also rely on homeopathic preparations, such as the remedies sulfur and Urtica urens for hives symptoms. However, there is no scientific evidence of their effectiveness.
The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.
How does the doctor recognize hives in children?
The diagnosis of “hives” is made by a pediatrician or a dermatologist. The same examinations and diagnostic steps occur in children as in adults.
Medical history and physical examination
First, the doctor asks the affected child or his or her parents a few questions to obtain a medical history (anamnesis). These include, for example:
- How long has the rash been present?
- In what situation did the symptoms occur (e.g., accompanying an infection, during physical exertion, after wearing tight clothing)?
- Does your child take medication? If yes, which ones?
- Does your child suffer from any other skin disease, allergies or asthma?
The physician then examines the child’s entire skin and mucous membranes. He takes a particularly close look at the skin rash.
This physical examination in combination with the medical history is usually sufficient for the doctor to diagnose hives. Further diagnostics are only necessary in certain cases.
Further examinations
The same applies if the itchy skin rash is such a burden on the child that he or she suffers greatly and his or her daily life (such as school, sports or playing) is impaired.
Further examinations, which are then sometimes useful, are for example allergy tests and blood tests. Rarely, it is also necessary to take a tissue sample (biopsy) of the skin to clarify hives in children, which is then examined in more detail in the laboratory.
Is hives dangerous in children?
There is usually no danger to the child from hives. However, the skin changes are unpleasant. Falling asleep, playing sports, concentrating on school: The permanent itching impairs the quality of life of some affected children.
It is dangerous if the hives occur in your baby or child as part of an allergic reaction, for example after an insect bite. If the mucous membranes of the respiratory tract and/or the tongue swell, breathing difficulties may occur. This is an emergency that must be treated immediately!
When to see a doctor?
It is advisable to have a child with hives examined by a pediatrician or dermatologist (dermatologist). The physician will then initiate a suitable therapy so that the child’s unpleasant skin rash subsides as quickly as possible.
