Urticaria 

Urticaria, also known as hives, are itchy, red welts caused by a skin reaction. These welts normally vary in size and can appear and frequently disappear as the reaction progresses.

They occur when the body develops an allergic response to an allergen, a normally harmless substance in many people. However, when the hives persist for an extended period, autoimmune or systemic conditions may develop. 

Urticaria in children can be itchy, or one may experience burning or stinging sensations. They can range in size from as small as a pinprick to as large as a dinner plate.

 

Types of Urticaria 

The common types of urticaria in children include:

Acute urticaria: This is the swelling that shows up abruptly and persists for less than six weeks. Acute urticaria is often caused by allergic responses to specific types of medicines and food.

Chronic urticaria: This type of urticaria lasts for six weeks or even more. The actual causes of chronic urticaria are unknown in over 95 percent of the conditions. However, it is considered urticaria autoimmune.

Physical urticaria: This occurs in precise conditions. It might be due to the hot, cold, or warm temperatures. It can be due to reactions to pressure or vibrations, sweating, and working out in some instances. They typically show up within an hour of contact. 

 

Signs and Symptoms of Urticaria

Wheals are skin swellings that develop on the skin as a rash. They are typically pink or red in color and round or oval. They might range in size from a few millimeters to many inches. They also comprise a red flare on them and could be so itchy.

Wheals typically form in clusters, most often on the face or within the extremities, such as the arms, fingers, hands, legs, toes, and feet. Welts usually vanish within 24 hours, though new ones can develop. They could form on only one or several sections of the body.

Also, urticaria symptoms usually go away after 24 hours, and another one may occur as the previous one disappears. Hives can last for several days in some cases. On the other hand, chronic hives might cause symptoms for several months or even years.

 

Causes of Urticaria 

Urticaria develops due to the body's reaction to an allergen and produces chemicals under the skin surface, including histamine. These chemicals and histamine are responsible for triggering inflammation and fluid buildup beneath the surface of the skin. Hence, it leads to wheals.

The exact cause is never identified in over half of the cases of urticaria.

The possible causes of urticaria in children are: 

  • Medication; certain medications such as antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), including aspirins and blood pressure medicine known as ACE inhibitors.
  • Food like nuts, food additives, shellfish, strawberries, eggs, and wheat products.
  • Bacterial infections such as strep throat and urinary tract infections.
  • Other infections, including the common cold, influenza, hepatitis B, and glandular fever.
  • Allergies to materials like latex or detergents.
  • Intense temperatures or change in body temperature due to warmth, cold or physical workout.
  • Plants such as poison ivy, poison oak, and nettles or nettles.
  • Chronic disease, including lupus and thyroid disease.
  • Scratching 
  • Too much exposure to sunlight 
  • Stings and insect bites 
  • Dust mites 
  • Cockroaches and cockroach waste

 

 Risk Factors of Urticaria 

Children who have a history of allergies are most likely to develop urticaria. They might also develop the condition if they are taking medication or if they unknowingly get exposed to allergens (things one is allergic to) like pollen or pollen. 

In addition, if the child gets an infection or a certain medical condition, he or she could be more susceptible to developing urticaria.

 

Urticaria Diagnosis 

A pediatric dermatologist is usually able to diagnose urticaria by examining the rash on the skin. He or she can perform allergy tests to determine the underlying cause of the reaction. These allergy tests can include:

Skin tests: This is also referred to as a scratch test or a skin prick. The provider is able to test for various allergens present in the skin with this type of test. When the skin becomes red or swells up, then the child is allergic to the substance. A skin test is not typically advisable in situations where the urticaria condition is chronic.

Blood tests: This test looks for certain antibodies present in the blood. Antibodies are produced in the body to fight off any allergens. However, if the body has a lot of antibodies, it could result in urticaria and swelling.

 

Urticaria Treatment 

The pediatric dermatologists will most likely suggest treating the symptoms using over-the-counter antihistamines. When self-care measures do not work, consult the doctor about the prescription drug or medication combination that works well for the child. In most cases, an effective form of treatment is found. 

Antihistamines:

Using non-drowsy antihistamine drugs regularly helps to obstruct the release of histamine, which causes symptoms. They are associated with few negative side effects. Some examples of antihistamine medications include;

  • Loratadine (Claritin)
  • Cetirizine (Zyrtec)
  • Fexofenadine (Allegra)
  • Desloratadine (Clarinex)

 

Other treatment medications 

Other medications may be helpful if antihistamines alone fail to ease the symptoms. Some of the drugs the dermatologist can recommend include;

Histamine blockers (H-2): These drugs, also known as H-2 receptor antagonists, can be taken orally or given through injection. Cimetidine (Tagamet HB) and famotidine (Pepcid) are examples of histamine blockers. 

Antidepressants: When used as a cream, the tricyclic antidepressant doxepin (Zonalon) can assist in easing itchiness. This medication has the potential to trigger drowsiness and dizziness. 

Anti-inflammatory medication: Prednisone and other oral corticosteroids can assist in reducing redness, swelling, and itchiness. They can result in severe side effects when taken for an extended period. Hence, anti-inflammatory drugs are generally used for the short-term management of serious urticaria. 

Monoclonal (man-made) antibodies: The omalizumab (Xolair) medication is highly effective in addressing a type of chronic urticaria that is difficult to manage and treat. It is an injectable drug that is normally administered once every month. 

Asthma medications that contain antihistamines: When combined with antihistamines, drugs that inhibit leukotriene modifiers' actions might be beneficial. Montelukast (Singulair) and zafirlukast (Accolate) are common examples.

Immunosuppressive medications: Cyclosporine (Gengraf, Neoral, and others), as well as tacrolimus (Astagraft XL, Prograf, Protopic), are immunosuppressive drugs options. 

 

Urticaria Home Remedies 

Children should learn to identify and stay away from the triggers. Although such triggers are not responsible for causing the problem, they tend to worsen the situation. Therefore, your child should learn to do the following: 

  • Avoiding or limiting alcohol consumption.
  • Staying away from some medicines.
  • Using mild cleaning agents, soaps, and skin ointments.
  • If possible, avoid stress by using relaxing practices and meditation.

Refraining from certain types of food that can be triggers is essential. Foods that are recognized to trigger the production of histamine are fish, meats, chocolate, yogurt, spinach, and tomatoes. 

One can lessen the irritation associated with urticaria by:

  • Staying away from the known triggers.
  • Wearing clothes that are light and loose-fitted.
  • Avoid the urge to scratch the irritated areas.
  • Having an oatmeal bath with tepid water.
  • To cool the irritated area, use cold water, fan, lotion, or a shower.

 

Preventing Urticaria 

After allergy tests, the pediatric dermatologist can easily figure out the triggers which lead to the swelling and urticaria. This makes it easier to detect and prevent them. The preventive measures include:

  • Avoid incorporating some foods and fluids into your meal plan.
  • Limiting your contact to airborne allergens.
  • Using non-scented soaps and detergents without dyes.
  • When feeling stressed, it’s advisable to take some time and relax.
  • Stay away from immediate changes in temperature.
  • Be sure to put on light-weight or just loose-fitted clothes.

 

Complications of Urticaria 

A child who has a serious allergic response may experience fatal swelling (or angioedema) along the air passage, which includes the lungs and throat. This medical problem is called anaphylaxis and has the potential to block the airways and even cause death. 

Anaphylaxis is frequently caused by a chronic allergic reaction to a specific food, such as tree nuts, peanuts, or a bee sting. Children suffering from anaphylaxis require an immediate injection of epinephrine, like injectable epinephrine. 

Epinephrine helps widens the airways, increases blood pressure, and alleviates swelling and urticaria. When epinephrine the child uses the injection outside the medical facility, a trip to the ER is recommended. This is because symptoms may reappear when the epinephrine wears out.  

 

Conclusion 

Urticaria and angioedema or swelling is a way in which the body reacts to a foreign substance (allergen). Such reactions can be unsettling, though they are not always severe. You can get urticaria alone, hives combined with swelling, or swelling only. 

These responses usually subside within one or two days. If your child is prone to urticaria or swelling, speak with the pediatric dermatologist about undergoing an allergy test. After determining what causes the allergies, you can take the necessary measure to avoid them.