Hives

See More Appropriate Topic (instead of this one):

• If it's probably mosquito bites, see Insect Bite
• If NOT, try one of these: Mosquito Bite
• If NOT, try one of these: Rash or Redness - Widespread
• Mosquito bites suspected, see Insect Bite

Is this your child's symptom?

• An itchy rash made up of raised pink bumps
• Most often, rash is very itchy

Symptoms of Hives

• Raised pink bumps with pale centers (welts)
• Hives look like mosquito bites
• Sizes of hives vary from ½ inch (12 mm) to several inches (cm) across
• Shapes and location of hives can be different. They can also change often.
• Itchy rash

Causes of Widespread Hives

• Viral Infection. The most common cause of hives all over the body is viral infections. Research has confirmed this. Other symptoms such as a fever, cough or diarrhea are also present. The hives may last 3 days. This is not an allergy.
• Bacterial Infection. Some bacterial infections can also cause hives. A common example is Strep. Hives are also seen with bladder infections. (UTIs)
• Drug Reaction. An example is a penicillin rash. Most rashes that start while taking an antibiotic are viral rashes. Allergy tests are normal 90% of the time. Only 10% turn out to be a drug allergy.
• Food Reaction. May be an allergy or a coincidence. If the food is a high risk one (such as peanuts), consult an allergist. Hives from foods usually resolve in 6 hours. Hives from infections last for days. Only 3% of hives are due to a food.
• Bee Sting. Widespread hives after a sting may be part of a serious allergic reaction. Need to consult an allergist.
• Anaphylactic Reaction (Very Serious). The sudden onset of hives with trouble breathing or swallowing. This is a severe allergic reaction to an allergic food or drug. Most often begins within 30 minutes of swallowing the substance. Always within 2 hours of exposure.
• Unknown. Over 30% of the time, the cause of hives is not found.

Causes of Localized Hives

• Irritants. Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy.
• Plants. Many plants cause skin reactions. Sap from evergreens can cause local hives.
• Pollen. Playing in the grass can cause hives on exposed skin.
• Pet Saliva. Some people get hives where a dog or cat has licked them.
• Food. Some children get hives if a food is rubbed on the skin. An example could be a fresh fruit. Some babies get hives around their mouth from drooling a new food.
• Insect Bite. Local hives are a reaction to the insect's saliva. Can be very large without being an allergy.
• Bee Sting. This is a reaction to the bee's venom. Can be very large without being an allergy.
• Localized hives are not caused by drugs, infections or swallowed foods. These get into the bloodstream and cause widespread hives.

Call 911 Now

• Hives and life-threatening allergic reaction to similar substance in the past and exposure less than 2 hours ago
• Trouble breathing or wheezing
• Hoarse voice or cough start all of a sudden
• Trouble swallowing, drooling or slurred speech start all of a sudden
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Hives start after eating a high-risk food. High-risk foods include nuts, fish, shellfish, or eggs.
• Hives started after taking a prescription medicine
• Age less than 1 year with hives all over
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Hives started after taking an over-the-counter medicine
• Severe hives (such as eyes swollen shut or very itchy)
• Fever or joint swelling is present
• Stomach pain or vomiting
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Hives make it hard to go to school or do other normal activities. Note: taking Benadryl for 24 hours has not helped.
• Food could be the cause
• Had hives 3 or more times in past year with no known cause
• Hives last more than 1 week
• You have other questions or concerns

Self Care at Home

• Hives with no other problems

Care Advice for Hives

1. Hives Only on One Part of the Body - What You Should Know:
   • Most are caused by skin contact with an irritant. Examples are plants, pollen, food or pet
     saliva.
   • Localized hives are not caused by drugs, infections or swallowed foods. They are also not an allergy.
   • Wash the allergic substance off the skin with soap and water.
   • If itchy, use a cold pack for 20 minutes. You can also rub the hives with an ice cube for 10 minutes.
   • Hives just on one part of the body should go away on their own. They don't need Benadryl.
   • They should go away in a few hours.
2. Hives All Over the Body - What You Should Know:
   • Over 10% of children get hives 1 or more times.
   • Most widespread hives are caused by a viral infection. This is not due to an allergy. Less than 10% are an allergic reaction to a food, drug, or insect bite. Often, the cause is not found.
   • Here is some care advice that should help.
3. Allergy Medicine for Hives All Over the Body:
   • Give Benadryl 4 times per day for hives all over that itch. Age limit: 1 and older.
   • Use an allergy medicine until the hives are gone for 12 hours.
   • If the hives last more than a few days, switch to a long-acting antihistamine, such as Zyrtec. No prescription is needed. Age limit: 2 and older.
   • Caution: if your child is less than 1 year, call your doctor for advice.
4. Hives Caused by Foods:
   • Foods can cause widespread hives.
   • Sometimes, the hives are just around the mouth.
   • Hives from foods usually last just a short time. They often are gone in less than 6 hours.
5. Cool Bath for Itching:
   • To help with the itching, give a cool bath. Do this for 10 minutes. Caution: Avoid causing a chill.
   • Can also rub very itchy spots with an ice cube for 10 minutes.
6. Wash Allergens Off Body:
   • Give a bath or shower if caused by pollens or animal contact.
   • Change clothes.
7. Stay Away from Allergens:
   • If you know what is causing the hives, avoid this substance. An example is certain foods.
   • Help your child stay away from this allergen in the future.
8. Return to School:
   • Hives cannot be spread to others.
   • Your child can go back to school once feeling better. The hives shouldn't keep him from normal activities.
   • For hives from an infection, can go back after the fever is gone. Your child should feel well enough to join in normal activities.
9. What to Expect:
   • Hives all over from a viral illness normally come and go.
   • They may last for 3 or 4 days. Then, they go away.
   • Most children get hives once.
10. Call Your Doctor If:
    • Severe hives not better after 2 doses of Benadryl
    • Itch not better after 24 hours on Benadryl
    • Hives last more than 1 week
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.