HIVES

Main Symptoms

  • Raised pink bumps with pale centers (welts)
  • Hives look like mosquito bites
  • Sizes of hives vary from ½ inch to several inches across
  • Shapes of hives are variable and change repeatedly
  • Itchy rash

Causes

  • Widespread hives usually are caused by a viral infection.  Can also be an allergic reaction to a food, drug, infection, insect bite, or other substances.
  • Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Localized hives are not caused by drugs, infection or swallowed foods.

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WHEN TO CALL YOUR DOCTOR FOR HIVES

Call 911 Now (your child may need an ambulance)(for symptoms of anaphylaxis)If

  • Difficulty breathing or wheezing
  • Hoarseness or cough with rapid onset
  • Difficulty swallowing or slurred speech with rapid onset
  • Severe allergic reaction in the past to similar substance

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick.
  • Hives began after a bee sting, unusual food or medicine and no previous reactions

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • You think your child needs to be seen.
  • Severe hives (eyes swollen shut, very itchy, etc.) not improved after 2nd dose of Benadryl
  • Fever, abdominal pain or joint swelling is present

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns.
  • Hives interfere with school or normal activities after taking Benadryl every 6 hours for more than 24 hours
  • Unexplained hives have occurred 3 or more times

Parent Care at Home If

  • Hives with no complications and you don't think your child needs to be seen
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HOME CARE ADVICE FOR HIVES

  1. Localized Hives: For localized hives, wash the allergic substance off the skin with soap and water. If itchy, massage the area with a cold washcloth or ice. Localized hives usually disappear in a few hours and don't need Benadryl.
  2. Localized Hives: For localized hives, wash the allergic substance off the skin with soap and water. If itchy, massage the area with a cold washcloth or ice. Localized hives usually disappear in a few hours and don't need Benadryl.
    • Contraindication: Weight < 20 pounds (Reason: Benadryl is a sedative). Give your doctor a call for advice.
    • Continue the Benadryl 4 times per day until the hives are gone for 12 hours.
  3. Cool Bath: Give a cool bath for 10 minutes to relieve itching.  (Caution: avoid any chill)  Rub very itchy areas with an ice cube for 10 minutes.
  4. Remove Allergens: Give a bath or shower if triggered by pollens or animal  contact.  Change clothes.
  5. Avoid Allergens: If you identify a substance that causes hives, help your child avoid that substance in the future.
  6. Contagiousness:  Hives are not contagious. Your child can return to day care or school if the hives do not interfere with normal activities.
  7. Expected Course: Hives normally come and go for 3 or 4 days, then disappear. Most children get hives once.
  8. Call Your Doctor If:
    • Severe hives persist after 2nd dose of Benadryl
    • Most of the itch is not relieved within 24 hours on continuous Benadryl
    • Hives last > 1 week
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 7/2002

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