Hives or Urticaria, Cause and Symptoms
Hives or Urticaria
Hives, also known as urticaria or nettle rash, affects about 20 percent of people at some stage in their life. It usually starts as a raised itchy patch that appears on the skin then turns into swollen red welts when triggered by certain substances or situations. Hives in children and adults can be mild or severe but it can worsen if there is scratching, exercise or emotional stress.
The rash, which ranges from few millimeters to size of a hand is usually very itchy and normally settles within few days.
Hives symptoms can last between few minutes to months-even years. Hives resemble each other but they can be different in many ways. Hives in children may appear in any area of the skin where they may move around, change shape, appear and disappear instantly.
Raised red or skin-colored itchy bumps (wheals)-they appear suddenly and go away in no time.
Blanching-when the bumps are pressed at the center they turn white.
If as a result of hives, a child develops swelling in the throat or symptoms that restrict breathing they should seek immediate emergency care.
There are two types of Hives that can affect children:
Acute urticaria- this is when the itchy rash disappears with six weeks but not life-threatening.
Chronic urticaria- this is a type of hives that is typically itchy, and it persists for more than six weeks. It occurs almost daily and lasts less than 24 hours without leaving a scar or a bruise.
When to visit an allergist
If a child experience hives lasting more than a month or if they recur, they should be taken to an allergist. The allergist will take the child’s history and perform a comprehensive physical exam to determine the cause of the symptoms.
You should also consult your allergist if the child’s symptoms are:
- Causing distress and anxiety
- Disrupting the child’s activities such as play and school work
- Occurring alongside other symptoms
What causes Urticaria?
Urticaria or hives occurs when a trigger prompts the release of high levels of histamine and other hormones in the skin. As a result, these substances causes the blood vessels in the affected area of the skin to bulge (often resulting in redness or skin-colored) and produce welts. It is these welts or wheals that cause swelling and itchiness.
The triggers of hives can be quite obvious in some cases, such as when a child eats peanuts or shrimp and breaks out immediately. In other cases, a detective investigation by both the patient and the doctor is required because there may be many possible causes.
One episode of hives may not require an extensive testing. To get rid of hives that are triggered by certain foods, keep track of what the child eats. This can help you determine if there’s a link between what the child eats and when hives break out.
If you suspect your child has chronic hives, let them see an allergist, who will examine your family medical history, any medications the child has taken recently, exposure to pets or animals and the substances to which the child has been exposed to at home and at school. This is the best time to show to the allergist the food diary if you’ve been keeping one.
Your allergist may want to ask you the some of the following questions to determine what might have triggered the symptoms:
- When and where the itchy rash began
- Details of the child’s diet or what they had to eat to trigger the symptoms
- If the child started taking any medications just before the symptoms began
- If within the current environment, your child has come into contact with possible triggers such as latex, pets or chemicals.
- If just before the symptoms started, the child was stung or bitten by an insect
- Your child’s current health status and if they have been affected by infections recently
- If your family have a history of urticaria
An allergist may want to conduct a blood test, skin tests, and urine tests to determine the cause of child’s hives. If it is suspected that a specified food is a trigger, your allergist may carry out a skin prick test to confirm the diagnosis. If the result is positive, your child is likely to be advised to avoid that particular food. Allergists, in rare cases, may recommend an oral food challenge.
This is a carefully monitored test in which the child is made to eat a measured amount of suspected allergy trigger to see if the hives will break out. Similar tests can also be done for suspected medication triggers with the use of cautious medication challenge tests to confirm the diagnosis. These challenge tests should be conducted under strict medical supervision so as to combat the possibility of anaphylaxis shock, a life-threatening allergic reaction.
Your child may be subjected to a number of tests to find out the underlying cause of hives in your child. Such tests include:
- A full blood count test (FBC) – this is beneficial as it may identify anemia.
- Tests that examine the antibodies levels in the child’s body
- A stool sample- this can help identify intestinal parasites
- An erythrocyte sedimentation rate (ESR) test- this is aimed at identifying if there are problems with the child’s immune system.
- Thyroid function tests- this is carried out to check for hypothyroidism (underactive thyroid gland) and hyperthyroidism (overactive thyroid gland)
- Liver function tests- these are tests carried out to check if there are problems with child’s liver.
- In cases where vasculitis is the suspected cause of hives in children, a skin biopsy which is then sent to a dermatopathologist to be examined under a microscope, may be performed by your allergist.
Management and treatment of hives
Of the several factors researchers have identified as the cause of hives, food and medication substance are the major causes. The various causes of hives include:
- Some foods such as peanuts, shellfish, eggs and nuts
- Blood transfusions
- Medications, such as aspirin, ibuprofen, and antibiotics (penicillin and sulfa)
- Physical stimuli such as cold, pressure, heat, sun exposure or exercise
- Bacterial infections, such as urinary tract infections and strep throat
- Viral infections, including infectious mononucleosis, common cold, HIV and hepatitis
- Pet dander
- Some plants, such as poison ivy and poison oak
- Emotional stress or anxiety
- Drinking alcohol or caffeine
- Insect bites and stings
Treatment for hives
In most cases, treatment for hives isn’t that necessary because the symptoms are usually mild and dissipate within a couple of days. However, for persistent or troublesome symptoms, take your child to an allergist for an immediate treatment.
The frequently recommended treatment for hives is antihistamines, which is available either by prescription or over the counter. They block the effect of histamines-a chemical in the skin that causes the symptoms of allergy such as welts. Antihistamines that are low-sedating or non-sedation are preferred because they are effective and long-lasting with few side effects. Examples of antihistamines are cetirizine, fexofenadine and loratadine. Your allergist may recommend a combination of two or three antihistamines together with cold compresses or anti-itch salves that ease the symptoms, to treat your child’s hives.
When hives become severe, a temporary treatment with the prednisone-an immune modulator or a corticosteroid medication such as prednisolone may be required to help reduce the severity of the symptoms. Corticosteroids work by suppressing the immune system so as to lessen the symptoms of urticaria in children. Your allergist may recommend for your child a course of prednisolone that lasts between three to five days.
The possible side effect of taking corticosteroid tablets are increased appetite, mood change, weight gain and insomnia (difficulty sleeping). It is important to note that it is not recommended for a child or an adult to take corticosteroid medication for long-term, as it can lead to a wide range of side effects and complications. Side effects can range from high blood pressure (hypertension), glaucoma, cataracts to diabetes.
If the child’s reactions include swelling of tongue or lips, or they have trouble breathing, then the best treatment your allergist may prescribe is epinephrine (adrenaline). It is an auto-injector the child keeps on the hand at all times. These symptoms can signal a potential of anaphylaxis- a fatal allergic reaction that impairs the child’s breathing and sends the body into a shock. Anaphylaxis can only be treated with epinephrine.
If your child develops hives and the injector is not nearby, they should immediately be taken to an emergency room. Even after using an auto-injector, children with hives should go to an emergency room.
To help reduce the itchiness caused by hives, your allergist may prescribe menthol cream in addition to antihistamines.
The types of antihistamines you obtain from the pharmacist are called H1 antihistamines. However, other types of antihistamines, including H2 antihistamines are available. are majorly used to treat chronic hives because they narrow blood vessels, helping to reduce skin’s redness and bulging. H2 antihistamines can be combined with H1 antihistamines or simply be used as an alternative to H1 antihistamines. H2 antihistamines side effects are rare but can include a headache, diarrhea, and dizziness.
Leukotriene receptor antagonists
These are types of medications give to children to help reduce the redness or swelling of the skin. Leukotriene receptor antagonists have rare side effects and are used as a long-term alternative to corticosteroid tablets.
Ciclosporin is a powerful medication that has proved to treat urticaria in about two-thirds of cases. It functions in a similar way as corticosteroid by suppressing the harmful effects of the immune system. However, it has side effects that include hypertension, kidney problems, headaches, involuntary shaking (tremors), increased level of blood cholesterol and increased vulnerability to infections such as UTIs and chest infections.
This is a newer medication becoming available for urticaria that doesn’t respond to antihistamines. Omalizumab, given through an injection, is thought to reduce the antibody that plays a part in hives.
If the cause of hives is successfully identified, the best way to get rid of hives is to avoid the triggers or eliminate it as follows:
Food: Avoid giving your child all types of foods that have been identified to cause urticaria
Scratching or rubbing: Don’t use harsh soaps. Itching and scratching can worsen hives. Ensure your child takes frequent baths to reduce scratching and itching.
Constant pressure: Restrain your child from putting on tight clothing. Loose-fitting clothes will reduce pressure hives considerably.
Temperature: If exposure to cold causes hives in your child, ensure they avoid swimming alone in the cold and that they carry with them an auto-injector at all times. If the child has to be out in the cold, let them wear warm clothing together with a scarf around their nose and mouth.
Sun exposure: Ensure your child wears sun-protective clothing such as long-sleeved shirts and trousers. In some instances, apply sunblocks.
Medications: If you suspect that a specific medication is causing your child’s hives, notify the pharmacist or physician immediately so that it can be stopped.
This is an allergic condition in which hives lasts more than six weeks to months or even years. Chronic hives occur when the immune system of the body begins to attack its own tissues in a condition known as the autoimmune reaction. This condition occurs as result of the combination of:
Rheumatoid arthritis occurs when the immune system attacks the joints
Lupus-the immune system attacks the skin and the joints making children feel tired most of the time
Chronic hives can be associated with other chronic illnesses such as:
- Intestinal parasites
- Viral hepatitis
- Hypothyroidism (an underactive thyroid gland)
- Hyperthyroidism (an overactive thyroid gland)
- In some cases, the cause of chronic hives may not be identified even after a detailed history and testing. In such condition, it is called chronic idiopathic urticaria. Sometimes chronic hives can be associated with thyroid disease, hormonal problems or cancer (rare cases). Even chronic urticaria dissipates over time.
- To get rid of chronic hives, avoid its triggers, such as:
- Warm temperatures
- Constant pressure on the skin especially wearing tight clothing
- Medications such as the painkiller codeine and NSAIDs
- Insect bites and stings
- Certain food additives such as salicylates found in tomatoes, tea, and orange juice.
- Physical urticaria
An exposure to a physical cause such as heat, pressure or cold can cause what is known as physical urticaria. Listed below are the common triggers of physical hives in children:
Scratching or rubbing (simple dermographism): This is the most common cause of physical hives in children. If the child scratches or rubs a particular area on their body, symptoms appear within a few minutes and typically disappear in less than an hour.
Pressure or constriction: A red swelling that appears six to eight hours after pressure was applied, such as pressure by belts or constrictive clothing can be as a result of delayed pressure urticaria. Symptoms can also occur on the soles of the feet due to constant pressure.
Temperature change: Cold urticaria comes as a result of exposure to low temperatures followed by warm temperatures. A typical example is plunging into a cold pool. This can be severe and life-threatening because there is a general body cooling.
High body temperature: Cholinergic urticaria can occur as a result of the temperature of the body increases due to sweating, exercise, anxiety and hot showers.
Sun exposure: Solar urticaria may occur within a few minutes when your child is exposed to the sun.
Another notable cause of hives in children is due to vasculitis (inflammation of blood vessels). This type of hives is particularly painful than itchy and may leave a bruise on the skin of the child. It normally lasts more than 24 hours.
Angioedema is when deep tissues beneath the surface of the skin swells and can be mistaken or be associated with hives. Angioedema is caused by allergic reactions, hereditary deficiency of some enzymes or medications. When a child exhibits the following symptoms, then they may be suffering from angioedema and not hives:
- Swelling in the mouth or eyes
- Swelling of the throat, hands or feet
- Stomach cramps, difficulty breathing or chemosis (swelling of the lining of the eyes)
- Idiopathic angioedema can be treated using antihistamines and steroid medications
This is a severe life-threatening allergic reaction that can normally begin simply as urticaria before become severe by impairing the child’s breathing and sending the body into a shock. Its symptoms include:
- Swollen lips, eyes, feet, and hands
- Abdominal pain, nausea, and vomiting
- Feeling faint or light heads
- Narrowing of the airways, causing wheezing and difficulties with breathing
- Collapsing and the child becoming unconscious
Anaphylaxis can be treated by giving the child adrenaline auto-injectors. Anaphylaxis should always be treated as an emergency.