Urticaria (hives)

At Advocate Children's Hospital, we understand how uncomfortable and worrying hives can be for you and your child. Our expert allergists are here for you to find the answers you need and get to the cause of what’s causing your child’s hives.

Hives, also known as urticaria, are a common skin condition that causes raised, itchy, red bumps to appear on the skin. These itchy welts, sometimes called “weals,” can develop suddenly and often appear in reaction to seasonal, food or drug allergies and insect stings. Hives can also be caused by stress or even temperature changes.

For some children, hives may be a one-time occurrence, while others may have outbreaks that keep coming back.

Do hives spread by scratching?

Hives themselves aren’t contagious and can’t spread from one area of the body to another. However, scratching can cause the skin to become more irritated, potentially worsening the appearance of the rash or causing additional discomfort.

It’s best to avoid scratching hives, as it can make the inflammation worse and cause symptoms to last longer. If your child has hives, wearing soft, cool clothing and applying soothing lotions may help reduce the urge to scratch.

What do hives look like?

Hives typically look red with bumps raised on the skin that may resemble mosquito bites but aren’t directly caused by contact with an insect. However, they can be caused by an allergic reaction to a sting or insect bites.

Hives are usually itchy and can be described as "raised and splotchy" or as having a “welty” appearance. These welts can appear anywhere on the body, including the face, arms, legs, and torso.

In some cases, hives may feel warm to the touch, especially if there’s an allergic component involved. The size of the welts can vary depending on the severity of the reaction and may expand or shift locations on the body over a few hours.

What causes hives?

Hives can be triggered by a range of factors, including:

• Allergic reactions: Common allergens include certain foods such as nuts, shellfish or eggs, medications, and insect bites or stings.
• Environmental triggers: Physical factors like cold (cold urticaria) or heat, pressure on the skin, sunlight or exercise can lead to stress hives or other types of reactive hives.
• Stress: Emotional or physical stress can sometimes lead to hives, which can be just as uncomfortable as allergy-induced hives.
• Infections: Some viral or bacterial infections may lead to hives.
• Unknown causes: In many chronic urticaria cases, a specific trigger cannot be identified, and hives may appear spontaneously.

What foods trigger urticaria?

Certain foods are common causes for hives, especially in children prone to allergic reactions. Foods that may cause hives include:

• Shellfish, such as shrimp, lobster or crab
• Peanuts and tree nuts
• Eggs
• Milk
• Wheat and gluten-containing foods

It’s essential to monitor any symptoms that follow eating these foods. If your child has experienced hives after eating certain foods, an allergist can help identify specific food allergies and recommend a safe eating plan.

Symptoms of hives

Hives can cause various symptoms, including:

• Red, raised bumps that can be as small as a pea or as large as a grape
• Itchy, irritated skin that may feel warm
• Welts or lumps that change shape or move locations on the body
• Swelling in areas like the eyelids, lips or face (angioedema), often accompanying hives on the skin

How are hives diagnosed?

Diagnosing hives typically involves a physical exam and a review of your child’s medical history, including recent exposure to potential allergens. In some cases, your doctor may recommend seeing an allergist or dermatologist to determine what’s causing the hives.

Allergy testing can help determine if allergens are causing your child's hives. Testing can be done on the skin or through blood tests and pinpoint specific allergies your child may have.

Hives treatment and management

With the right care, hives can be managed effectively. Treatment for hives aims to reduce symptoms and prevent future outbreaks, especially in cases of chronic urticaria. Options include:

• Antihistamines: Over-the-counter or prescription antihistamines are often used to manage hives by reducing itching and swelling.
• Cool compresses: Applying cool cloths to affected areas may help soothe itchy skin.
• Avoiding known causes: If a specific allergen has been identified, avoiding it can significantly reduce the occurrence of hives.
• Medications for chronic hives: In cases where standard treatments don’t provide relief, other options such as corticosteroids may be recommended.
• Lifestyle adjustments: Managing stress and avoiding sudden temperature changes may help reduce episodes of stress hives or cold urticaria.