Caring for a child who lives with chronic urticaria (chronic hives) can be hard. Hives can affect how they sleep or how they feel at school, which can be uncomfortable and even disrupt their lives and their schedule. Some kids find that having chronic hives makes them feel anxious or self-conscious, which can affect their quality of life and overall emotional health.

Because you want the best life for your child, it’s important to understand chronic hives. Then, you can make sure your child gets the right diagnosis and the best possible treatment for their needs. Here’s what you need to know.

Signs and Symptoms of Chronic Hives in Kids

Chronic hives look like regular hives. The difference is that they last for longer than six weeks, rather than for a shorter period of time. Sometimes, you may see symptoms of chronic hives go away only to return a few days later.

Hives are bumps on your skin that are raised above the rest of your skin, like welts or wheals. They may sting, hurt, or itch. They usually turn white when you press on the bump, and they can cause swelling, or angioedema. They often look like light red, dark red, gray, or purple, depending on your underlying skin tone.

You may see a bunch of hives appear all together, and they can combine to affect a larger area of skin. Some people see hives change their shape, and they may be mistaken for mosquito bites (or other insect bites) at first.

In fact, it can be easy to confuse hives with other rashes. Most of the time, hives won’t make your child’s skin flake, peel, or get dry like these rashes can. They also don’t usually leave lasting marks on your child’s skin. Some viruses can cause rashes, but these don’t usually itch as much or make your child uncomfortable. But it can be hard to make these distinctions, so if you’re concerned, the best thing you can do is take your child to see a dermatologist.

Causes of Chronic Hives in Kids

There are two types of hives that are chronic or ongoing. They’re classified based on whether or not healthcare professionals can find a cause. Chronic spontaneous urticaria (CSU), previously called chronic idiopathic urticaria (CIU), doesn’t have a cause that doctors can find. Chronic inducible urticaria (CIndU) has a known trigger.

All chronic hives have to do with changes in the immune system. Basically, the immune system gets triggered and causes allergylike symptoms, even if there’s no specific substance (called an allergen) that triggers it. This may be a case where the body has an autoimmune response, in which it attacks itself, though this hasn’t been shown to be true in children yet.

Some other diseases may lead to chronic hives. These include asthma, certain bacterial infections, and inflammation of the blood vessels known as vasculitis.

Changes in the physical environment may also be triggers for some people. These include:

• Excessive heat or cold
• Exposure to vibration, water, or sunlight
• Pressure on the skin from clothes or something else
• Exercise or physical activity

Occasionally, people may consume a food or a medication that they’re allergic to regularly enough that it triggers chronic hives.

Diagnosing Chronic Hives in Kids

Your child’s pediatric healthcare provider or allergist/immunologist may order a variety of tests to diagnose chronic hives. These include tests to rule out other conditions. For instance, they may do blood or urine tests to see if there’s a bacterial or other infection present.

They usually start by examining your child’s body. They’ll also want to hear about when the hives started, how long they have lasted, and any patterns around them. For instance, if the hives get worse after your child plays sports or when they wear certain clothes, this can help your doctor make the right diagnosis.

They may ask you to track your child’s symptoms over time. You’ll need to write down when they do or don’t have hives, when their hives get worse or improve, and more. They may also ask you to track what your child eats and what medications they take to see if there’s a connection.

Your doctor may also perform an allergy test. This can be helpful, but it may not give you much information. If your child doesn’t seem to have allergies or the hives don’t show up after they’re exposed to things they’re allergic to, the test may not be able to tell you very much.

Finally, in rare cases, your child’s doctor may do a skin biopsy. Here, they take a sample of a hive and send it to a lab for testing. This allows them to make sure they’re making the right diagnosis and to rule out other possible skin conditions at the same time.

Managing Chronic Hives in Kids

If your child has had hives for more than six weeks, their hives are changing significantly, or the hives are causing significant problems in daily life, it’s time to see a doctor and get some help. There are a few treatment options available for kids dealing with chronic hives. The goal of treating chronic hives is usually to keep the symptoms under control until the underlying cause resolves itself. This can take a long time, though, or the condition may be chronic throughout their lifetime.

If there are things that trigger your child’s chronic hives, a big part of treatment is avoiding those triggers. Beyond that, most immunology specialists will start treating chronic hives with allergy medications or antihistamines. These may be able to stop the immune system issues even if no allergen is present.

If that doesn’t work and your child is 12 or older, they may try a medication that attaches to certain immune system substances and stops them from causing hives. If that doesn’t work, or if your child isn’t old enough to take it, they may offer a medication that suppresses the immune system overall. This medication is very effective, but it can have serious side effects if your child takes it for a long time.

If your child’s symptoms are severe, are interfering with daily life, or won’t go away, steroids may help them feel better, too. These aren’t usually used alone because they don’t address the underlying problem, but they can give some relatively quick relief.

If your child is also diagnosed with an autoimmune disease, there are other medications they can take. These aren’t necessarily helpful to people without these diseases, but they can be useful in treating chronic hives alongside these other conditions.

When To Seek Emergency Treatment for Chronic Hives in Kids

Sometimes, hives can be signs of a serious allergic reaction called anaphylaxis. This requires urgent medical attention and can be life-threatening. Get emergency medical help immediately if your child:

• Is struggling to breathe
• Has swollen lips or a swollen tongue
• Is drooling
• Has a high fever
• Is vomiting
• Is also experiencing joint pain

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On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.

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