Why does my child keep getting hives? Understanding chronic urticaria in children.
By Associate Professor Alberto Pinzon Charry
Paediatric allergist and immunologist in Woolloongabba, Brisbane
Seeing your child suddenly develop red, raised, itchy welts can be alarming.
When the rash disappears, only to return days or weeks later, it’s natural to wonder what’s causing it, and whether an allergy is to blame.
While hives (also known as urticaria) are common in children, they aren’t always the result of an allergic reaction. In fact, many cases of recurring hives have other causes, and understanding the difference is an important first step in finding the right treatment.
What are hives?
Hives are raised, itchy patches or welts that can appear anywhere on the body. They often vary in size and shape and may join together to form larger areas of swelling.
One of the distinctive features of hives is that individual spots usually disappear within 24 hours, although new ones may appear elsewhere on the body.
Some children also develop swelling beneath the skin, particularly around the eyes, lips, hands or feet. This is known as angioedema and can occur with or without hives.
What causes hives?
Hives develop when certain cells in the skin release histamine and other inflammatory chemicals. This causes small blood vessels to leak fluid, resulting in the characteristic itchy, raised rash.
Although allergies are often suspected, they are only one possible cause.
Other triggers may include:
- viral infections
- bacterial infections
- certain medications
- heat or cold
- pressure on the skin
- exercise.
In many cases, no specific trigger can be identified.
What is chronic urticaria?
Hives are described as chronic urticaria when they occur on most days for six weeks or longer.
This can be frustrating for families because the rash may seem unpredictable, appearing and disappearing without warning.
Unlike short-lived episodes of hives, chronic urticaria is less likely to be caused by a food allergy. Instead, it is often related to ongoing activation of the immune system, although the exact cause isn’t always clear.
Does my child need allergy testing?
Not necessarily.
One of the most common misconceptions is that recurring hives automatically mean a child has developed a food allergy.
If hives occur immediately after eating the same food on more than one occasion, allergy testing may be appropriate. However, for children with chronic urticaria, routine allergy testing often doesn’t identify the cause.
A paediatric allergist and immunologist will consider your child’s symptoms, medical history and any patterns before deciding whether further investigation is needed.
When should you seek medical advice?
While most cases of hives are not dangerous, it’s important to seek medical review if:
- hives continue to recur for six weeks or longer
- the rash is interfering with sleep or daily activities
- swelling is becoming more frequent or severe
- symptoms are difficult to control
- you are unsure whether an allergy could be involved.
If your child develops difficulty breathing, persistent coughing, wheezing, throat tightness or collapse together with hives, this should be treated as a medical emergency and urgent medical care should be sought.
Can chronic urticaria be treated?
Yes. Although chronic urticaria can sometimes take time to settle, effective treatments are available to help control symptoms and improve quality of life.
Management focuses on identifying any contributing factors where possible, relieving itch and reducing the frequency and severity of flare-ups. Every child is different, so treatment is tailored to their individual symptoms and circumstances.
Living with chronic hives
Recurring hives can be unsettling for both children and parents, particularly when there is no obvious explanation for each flare-up. The reassuring news is that most children with chronic urticaria improve over time, and many eventually outgrow the condition.
Understanding what is and isn’t likely to be causing the hives can help families avoid unnecessary dietary restrictions or testing and focus on the most appropriate treatment and ongoing care.
