Urticaria (Hives) in Children

Urticaria (Hives) in Children

Urticaria, commonly known as hives or nettle rash, is a common skin condition characterised by raised, itchy, red or skin-coloured welts (wheals) that can appear anywhere on the body. It affects up to 20% of people at some point in their lives and is particularly common in children.

Dr Mugilan Anandarajan provides specialist assessment and management of urticaria for children at Kingsbridge Private Hospital and Ulster Independent Clinic in Belfast.

Types of Urticaria

Acute Urticaria

Acute urticaria lasts less than six weeks. It is the most common form in children and is often triggered by:

• Viral infections (the most common cause in children)
• Food allergy (e.g. peanut, egg, milk, shellfish)
• Drug reactions (e.g. antibiotics, NSAIDs)
• Insect stings
• Contact allergens

Chronic Urticaria

Chronic urticaria lasts more than six weeks. In most cases, no specific trigger is identified (chronic spontaneous urticaria). It can significantly impact quality of life and requires specialist management.

Physical Urticaria

Physical urticaria is triggered by physical stimuli such as pressure, cold, heat, exercise or sunlight. Dermographism (skin writing) — where firm stroking of the skin produces a wheal — is the most common form.

Symptoms

• Raised, itchy wheals (welts) that can vary in size from a few millimetres to several centimetres
• Wheals that typically resolve within 24 hours but may recur
• Swelling of the deeper skin layers (angioedema) — particularly affecting the lips, eyelids, hands and feet
• In severe cases, angioedema can affect the throat and airways

Assessment and Diagnosis

Assessment involves a detailed clinical history to identify potential triggers and determine the type of urticaria. Investigations may include:

• Allergy testing (skin prick testing and specific IgE blood tests) where food or drug allergy is suspected
• Blood tests to exclude underlying causes in chronic urticaria
• Physical challenge tests for physical urticaria

Treatment

• Antihistamines: Non-sedating antihistamines are the mainstay of treatment for urticaria. Higher doses may be required for chronic urticaria.
• Trigger avoidance: Where a specific trigger has been identified, avoidance advice will be provided.
• Adrenaline auto-injector: Prescribed for children with urticaria associated with anaphylaxis risk.
• Omalizumab: A biologic treatment for severe chronic spontaneous urticaria that does not respond to antihistamines. Referral to a specialist centre may be required.

For further information, also visit belfastallergyclinic.com and belfastchildrensclinic.com.