Urticaria

Urticaria, commonly known as hives, is a skin condition that affects children and adults alike. Urticaria occurs when histamine and other chemicals are released from the skin's mast cells, causing inflammation and fluid leakage into surrounding tissues. Urticaria is characterized by red, itchy, and raised welts on the skin that can vary in size and shape. While acute urticaria is short-lived, chronic urticaria persists for more than six weeks, causing significant discomfort. It can be accompanied by swelling of deeper tissues, a condition called angioedema. This section deals with its causes, triggers, and treatment options for children.

• Acute UrticariaSymptoms last less than six weeks and are often triggered by infections, foods, medications, or insect bites.
• Chronic UrticariaPersists for more than six weeks and may occur daily or intermittently. Triggers are harder to identify, and it may sometimes be linked to underlying autoimmune conditions.

• InfectionsViral infections are a leading cause of acute urticaria in children.
• Food AllergiesCommon culprits include nuts, eggs, shellfish, and dairy.
• MedicationsAntibiotics, pain relievers, and certain vaccines may trigger reactions.
• Environmental FactorsCold, heat, sunlight, or pressure on the skin can lead to physical urticaria.
• Chronic ConditionsIn chronic urticaria, triggers may not always be identifiable, but autoimmune responses are often involved.

• Red, raised, and itchy welts on the skin that blanch when pressed. They can involve any part of the body. The size of the hives can be variable from very small to very large.
• Welts may change in shape and location, disappearing and reappearing elsewhere.
• Swelling in areas like the lips, eyelids, or hands in cases of angioedema.
• In rare cases, difficulty breathing or swallowing, which requires immediate medical attention.

A thorough medical history and physical examination are usually sufficient to diagnose urticaria. In cases of chronic urticaria, additional tests such as allergy tests, blood tests, or a skin biopsy may be needed to identify underlying causes.

• AntihistaminesThese are the first-line treatment for urticaria. Non-drowsy antihistamines are preferred for children and can be taken regularly to control symptoms. The most commonly used antihistamines are cetrizine, levocetirizine, loratadine, desloratadine, fexofenadine and bilastine. For children with the acute urticaria, the treatment is usually given for period of around 2 weeks. For children with chronic urticaria, the treatment needs to be continued for a few months depending on a case to case basis. For severe cases, higher doses of antihistamines are recommended.
• Avoidance of TriggersIdentifying and avoiding triggers such as specific foods or environmental factors can prevent recurrences.
• Cool CompressesApplying a cool compress can provide temporary relief from itching and swelling.
• OmalizumabOmalizumab is a humanized, monoclonal anti-IgE antibody that binds specifically to circulating IgE molecules. Omalizumab has been shown to be highly effective in treating children with chronic urticaria who do not respond to higher doses of antihistamines.
• Emergency TreatmentIn rare cases where urticaria leads to difficulty breathing or swallowing, immediate treatment with epinephrine and emergency care is essential.

Urticaria in children can be distressing but is manageable with the right care and treatment. Early intervention with antihistamines, trigger avoidance, and specialist care can minimize discomfort and improve outcomes.

If your child is having urticaria or urticaria is not improving get in touch with the pediatric allergist to ensure the best care for your child.

Conclusion

Chronic urticaria in children is usually idiopathic (no cause can be found), but occasionally could be secondary to some physical stimuli. These situations are described as chronic inducible urticaria.

Chronic inducible urticaria can be induced by specific physical or environmental stimuli (cold, heat, exercise, pressure, sunlight, vibration, water, etc.).

If symptoms last less than six weeks, it is acute urticaria. If they persist or recur for more than six weeks, it is considered chronic urticaria.

Non-drowsy antihistamines like loratadine or cetirizine are commonly used for children.

Acute urticaria often resolves on its own, while chronic urticaria may require ongoing management. In children chronic urticaria can persist for a few months to few years depending on a case to case basis.