Hives (urticaria) are quite common in children. They may occur in response to a variety of substances, such as food, latex, medications or insect bites. Most hives are acute, meaning they disappear within a few days, but some cases are chronic and last weeks or longer. Hives are red, raised areas of skin that are often itchy. Hives range in size from 1mm to several centimeters in diameter, and sometimes several individual bumps may merge to form one larger patch. Several treatment options may be used.
Identification of Trigger
The most effective treatment of hives is to remove the substance that caused the reaction, and to avoid exposure to that substance in the future. For instance, if a new medication or antibiotic resulted in hives, stop the antibiotic and ensure that in the future, this antibiotic is not prescribed. If the hives evolved into a major allergic reaction including throat swelling, epinephrine should be used to quickly stop a severe reaction.
Antihistamines are anti-allergy medications that are the primary method of treating hives. H1 antihistamines work by blocking a certain type of cell (called the H1 receptor), so that the allergic reaction cannot continue. Examples of H1 antihistamines include diphenhydramine (brand name Benadryl), which can be taken orally or applied on the skin as a lotion; and hydroxyzine (Atarax). The standard dose of diphenhydramine in 2- to 11-year-old children is 1 to 2 mg/kg taken every 6 hours as needed (the maximum safe dosage is 50mg per dose, and 300mg total per day). In kids over 12 years old, the dosage is 25 to 50mg taken every 2 to 4 hours as needed; the most that should be taken in one day is 400mg.
Antihistamines work quite quickly and are effective; however both may be sedating to children when taken orally. Because of this, if a child's hives last more than just a few days, second-generation (newer) antihistamines may be indicated. Examples of second-generation antihistamines include loratidine (Claritin) and cetirizine (Zyrtec). A typical dose of loratidine in 2- to 5-year-old children is 5mg taken by mouth once daily; in children 6 and up the dose is 10mg taken by mouth once daily.
H2 antihistamines work by blocking another type of cell: the H2 receptor. Although they are not generally used alone, they serve to provide a "boost" to the H1 antihistamines and make them work better. In some cases, the pediatrician may first prescribe a few days of an H1 antihistamine and if that does not work, she may suggest that an H2 antihistamine, such as ranitidine (Zantac), be added.
Using steroid medication, such as prednisone, is generally suggested only if all other treatments have been tried and have failed. This is both because steroids are not as helpful in cases of acute hives, and because there are a wide range of severe side effects that may occur with continued use of steroids. One concern with giving steroids to children is the impact on their growth: according to Alan Rogol, M.D., Ph.D., of the University of Virginia, impaired growth may occur because of decreased bone formation and decreased secretion of growth hormone. However, a course of prednisone (taken daily for a few days, then tapered to every other day), may be effective in children whose hives have not improved with other treatments.
Other Treatment Options
Home remedies such as oatmeal baths and soothing lotions may also be applied to help treat the itchiness. Children may especially enjoy a warm bath, but may not be as enthusiastic about application of a lotion.
Most often, hives will go away on their own and leave no lasting damage.
- "UpToDate"; Denise S. Basow; 2009
- "CURRENT Diagnosis & Treatment: Pediatrics"; W.W. Hay, Jr., et. al; 2008
- Epocrates Online: Diphenhydramine, Pediatric Dosing