Hives, Hives and More Hives!

Hives in children, toddlers or infants

Many children develop hives, which are swollen, red welts that can be quite itchy. Often, the itching starts before the welts appear. Hives are a very common problem, and they are estimated to affect at least 20 percent of people at some point in their lives. When hives show up on children, they can be quite worrisome for parents and can last for some time if not treated properly.

Hives (or chronic urticaria) are often caused by allergic reactions to food or medicine but can also be caused by infections, stress or underlying health conditions. Although most clear up on their own within 24 hours, hives can last from days to weeks. Chronic hives and viral hives may last months or even years.

Below, Dr. Sara Anvari, Director of Research, Food Allergy Program at Texas Children’s and Associate Professor of Pediatrics at Baylor College of Medicine, answers common questions about hives and hives in children. Read the guide below to learn about hive treatment options, hives in children and how to help your child during a hives outbreak.

What are hives?

Hives are raised, itchy welts that appear on the skin. Often red or skin-colored, they can range in size from small spots to large patches. The medical term for hives is urticaria. Hives or urticaria occur when the body releases histamine in response to various triggers such as allergic reactions to food, medications, insect bites or environmental factors. In some cases, hives may be caused by viral infections, stress or unknown reasons. While hives are generally not life-threatening, they can be uncomfortable and, in rare cases, signal a more serious allergic reaction. Hives in children are more common, especially for children ages 1-4, but they can also show up in adults.

What do hives look like?

From infancy to adulthood, hives or urticaria present with a characteristic appearance regardless of age, affecting infants, children and adults similarly. “Hives look a lot like mosquito bites,” says Dr. Anvari. “The hive itself is a pale wheal surrounded by a red flare. They can show up anywhere on the body and can vary somewhat in appearance — hives can look like tiny little spots, swollen bumps, blotches or even large connected bumps.”

Hives vs. Rash

Hives are a type of rash, characterized by itchy welts on the skin. They are distinguishable from other rashes by their smooth, raised appearance. Hives — unlike other rashes — generally do not come with dryness, flaking or peeling, and they typically do not leave lasting marks on the skin.

Hives in children can be more concerning compared to rashes. Hives and rashes in children may look similar but have different causes and treatments. Hives are raised, itchy welts that often result from an allergic reaction and can appear suddenly, moving around the body. In contrast, rashes are usually flat, can vary in appearance, and may result from factors like viral infections, skin irritation, or eczema. Consult a doctor if your child has hives or a rash with other symptoms or if they don’t go away.

Hive symptoms:

Learn about hive symptoms and how hives may show up on children or adults:

Raised, Red Bumps: Often appear suddenly on the skin as welts or "wheals."
Itching: he raised areas are usually very itchy, although not always.
Swelling: Swelling around the affected area can occur, and in severe cases, there may be swelling of the lips, eyelids, or throat.
Shape and Movement: Hives can vary in shape and size, and they may move around the body or come and go throughout the day.
Blanching: When pressure is applied to the red areas, they may turn white temporarily.

Hives can last from a few hours to several days and may be triggered by allergens, stress, temperature changes or infections. If hives show up with a fever it may indicate another underlying medical condition and it’s best to consult your doctor.

Hives treatment for children, toddlers and babies

“Most antihistamines will help,” says Dr. Anvari. “But I recommend not using Benadryl during the day because it will make your child sleepy. You can also use topical hydrocortisone on the affected areas.”

What causes hives in children?

Acute urticaria in a child can be caused by infections, foods, medications, insect bites or blood transfusions. When a child develops acute hives, the first thing that usually comes to mind is, “What did she or he eat that caused this rash?” However, most cases of childhood hives are a result of infections.

Common causes of hives in kids:

Some infections that can cause hives in children include respiratory viruses (common cold), strep throat, urinary tract infections, hepatitis, infectious mononucleosis (mono) and many other viral infections
In an infant or a toddler who is being introduced to new foods, think about food allergy as a possible cause of the hives, especially peanuts, tree nuts, eggs, cow’s milk and fish or shellfish.
If your child develops hives while or shortly after playing outdoors, look at their skin for any signs of insect bites, especially fire ants in our area.
When a child develops hives while taking a medication, the hives could have been caused by the medication, but this gets tricky if the child is taking an antibiotic since the hives could also have been caused by the initial infection for which she was taking that antibiotic.

Are hives contagious?

“No, hives are not contagious,” says Dr. Anvari. “There’s no risk of contracting hives by making contact with urticaria on a child’s skin.”

Viral hives vs. Allergic hives in children

Most hives are caused by a viral infection. In fact, it is estimated that less than 10% are caused by allergic reactions to a food, drug or insect bite. However, it’s not uncommon for the cause to remain a mystery.

Viral hives

Viral hives often appear immediately after an infection and can be accompanied by other infection symptoms like cough, fever or diarrhea. They usually last 4-24 hours and do not require medication.

Allergic hives

Allergic hives appear within 1-2 hours of exposure to insect bites, food or medicine and fade quickly after treatment with antihistamines.

Other types of hives include:

Chronic hives: recurring hives that appear almost daily for 6 weeks or longer.
Environmental hives: hives caused by sun exposure, heat, cold, pollen or plants and clothing.
Systemic hives: hives caused by diseases like leukemia, thyroid conditions, lupus, and others.

When to worry about hives in child

“Hives are quite common, and they’re usually not a sign of a serious condition,” says Dr. Anvari, about hives in children. “However, they become worrisome when parents see other systemic problems that accompany the outbreak. For example, if your child is starting to complain about joint pains. Also, if there’s a strong family history of things like thyroid disorder or autoimmune conditions. If the hives last for six weeks or more, that’s considered chronic hives. I would definitely recommend bringing your child to see a doctor.”

Diagnosing hives: when to see a doctor or emergency care

A single episode of hives in an otherwise healthy child does not usually need extensive testing, as most of the time it is caused by a viral infection. For hives caused by infections, they may take up to three weeks to resolve, but antihistamines will usually help improve the hives until completely resolved.

However, if hives reoccur, you should see your pediatrician or an allergy specialist to evaluate possible causes. Once the cause of hives is identified, the best treatment is to avoid or eliminate that cause.

Parents should immediately seek emergency care if a child is experiencing any of the following symptoms:

Difficulty breathing
Swelling of the face, throat or inside of the mouth
Lightheadedness or fainting
A rash accompanied by vomiting or diarrhea

If the symptoms are relatively mild, urgent care is a safe option. For any kind of breathing difficulties, however — as well as swelling in the face and tongue, or a rash accompanied by sudden vomiting or diarrhea — parents should call 911 and/or go to the Emergency Room as quickly as possible.

Chronic hives (chronic urticaria)

Chronic hives, also known as chronic urticaria, are often a challenge for the child, parents and physician. The good news is that in most cases of chronic hives, they gradually disappear over time. For some children, they disappear in a few months, but in others they may continue to recur for several years. In these cases, it is more effective to take the medications daily than to wait for breakouts.

Chronic hives (chronic urticaria): causes

Chronic hives can also be caused by thyroid disease, other endocrine problems or, very rarely in children, cancer. There is a type of chronic hives called physical urticaria, in which hives are caused by rubbing or scratching the skin (dermatographism), constant pressure (pressure urticaria), by changes in temperature (heat or cold urticaria), or sun exposure (solar urticaria).

In many cases, we cannot identify the cause of chronic hives, and this is called idiopathic urticaria, or chronic autoimmune urticaria, when the immune system is suspected to be the root cause of the hives.

Chronic hives treatment for children (chronic urticaria treatment)

Chronic hives should be evaluated by an allergist who will take a very detailed history and may perform some testing (blood, urine or skin tests). Chronic hives are frequently treated by a combination of two or three antihistamines, and in more severe cases, short courses of steroid medications or long-term immune modulators. If hives involve swelling of tongue or lips, or are accompanied by trouble breathing, your child may be prescribed an epinephrine autoinjector to use in case of emergency.

Hives and how Texas Children’s Hospital in Houston and Austin can help

The Department of Allergy and Immunology at Texas Children’s has excellent clinical expertise in the diagnosis and treatment of children with allergy, asthma and primary immunodeficiency. Its world-renowned care team includes specialists in a Food Allergy Program whose sole focus is to improve the quality of life for infants, children and adolescents with food allergies.

To schedule an appointment, you can obtain a referral from your pediatrician and then call 832-824-1000.

For help with hives in children in Houston contact: 832-822-2778
For help with hives in children in Austin contact: 737-229-2400

Hives in children, toddlers or infants

What are hives?

What do hives look like?