Hives

Hives (or urticaria) are a particular rash in children and adults that is caused by histamine release in the skin, and because histamine is released, they have a classic appearance and are associated with itching. The classic hive is described as a “wheal and flare.” The wheal is the swelling or bumpy white part of the hive due to fluid released in the tissue, and the flare or redness of the skin is due to dilation of the blood vessels. 

Now many things can cause this type of rash, including viral infections, medicines, insect bites, changes in temperature, pressure, exercise, or even stress. But we mainly see hives in the setting of a possible allergy to something, whether it is a food allergy or direct contact allergy from animal dander or pollen or chemicals. The mainstay of treatment for hives is various antihistamines because if there is no histamine to be released, we would not even have the hive in the first place. The body takes care of getting rid of the actual rash eventually, but the itching can keep your kiddo up at night and make life rather miserable. So depending on their age, we will often recommend oral antihistamines such as Benadryl (diphenhydramine) or Zyrtec (cetirizine)/Claritin (loratadine)/Allegra (fexofenadine). Do not use topical Benadryl as this can actually sensitize a kiddo to Benadryl and cause an allergic reaction. If your doc wants to prescribe something topical, it is usually a mild steroid to stop a few spots of bad hives or allergic skin reactions. 

Now if the skin hives are associated with swelling (of the lips, eyes, or tongue) or trouble breathing, this can be the sign of a more life-threatening allergy, and that kiddo should be seen in the emergency room for treatment with epinephrine and monitoring while the rash and swelling resolve. 

The frustrating thing with hives is that often, we will never know the exact trigger, and the hives can come and go for weeks to months with no answer for why they are there in the first place. Again, treatment (as long as there are no signs of a worsening allergy) are those antihistamines we mentioned above. If your child gets these recurrent hives or chronic urticaria, it is best to keep a journal with information of what the kiddo was doing 15 min to 2 hours before the rash started to possibly try to identify a cause.