Urticaria in Children: How It Manifests and Why It Occurs

Only that morning the skin was clear, and after a walk there are pink raised spots on the chest and arms that the child scratches until he cries. This is how urticaria often begins. Let us look at what it looks like, why it appears, and when parents need a doctor.

What urticaria in children is

Urticaria, or hives, is a rash of intensely itchy, flatly raised pale pink wheals resembling a nettle sting mark. Doctors describe it as a group of conditions with itchy wheals and/or angioedema. Wheals can be an independent, usually allergic reaction to a trigger, or a manifestation of another disease.

The phenomenon is common: various forms of urticaria are diagnosed in 15–25% of people, and about one in three experiences it at least once in their life. Adults are affected more often than children.

What urticaria looks like in a child: main signs

The main symptom is an itchy rash: raised bumps or spots of various shapes, in one place or all over the body. In photos, the bumps look like formations from 2 mm to 1 cm, the spots from 1 cm to 8 cm, and some merge into groups.

• the skin itches, sometimes stings or burns;
• on light skin the elements are pink or red;
• on brown and dark skin the color of the rash is harder to notice;
• wheals can disappear and appear in a new place.

In photographs of urticaria in children, the elements rise above the skin and look swollen, so the texture is sometimes more noticeable than the shade. Breathing, swelling, and the child's general condition also matter.

Causes of urticaria in children: allergic and other

Most often the wheals are an allergic reaction to a medication or food: the body releases chemicals that cause the skin to swell. In children with other allergies, urticaria occurs more often. Other causes include infections and stress.

The list of common allergens includes medications (antibiotics, radiocontrast agents), sera, gamma globulins, bacterial polysaccharides, food products, and insect allergens. Pseudoallergic urticaria is caused by substances that release histamine.

Mechanism: the skin contains mast cells with a store of histamine. The cells are activated by an immune or non-immune pathway, histamine enters the tissue, blood vessels dilate, fluid leaks into the skin — and thus a wheal appears.

Acute and chronic urticaria: how they differ

The difference is in time. Acute spontaneous urticaria is wheals and/or angioedema that last less than 6 weeks. Chronic is itchy wheals with or without edema, spontaneous or triggered by a stimulus, for longer than 6 weeks.

Chronic urticaria can be spontaneous (cause unknown) and inducible — from cold, heat, vibration, pressure; several forms can coexist in one person. Chronic accounts for a quarter of all cases, with the peak occurrence between 20 and 40 years. Angioedema is recorded in every second patient with urticaria.

How urticaria is diagnosed in a child

Usually a skin examination and a conversation are enough: when the wheals appeared, how long they last, whether they change location, what the child ate, what medications he received, whether there were infections and insect bites, whether the rash occurs after cold or pressure.

Duration matters: longer than 6 weeks is already the chronic form, and the examination is structured differently. Parasites are a rare cause of chronic urticaria, and before antiparasitic treatment, laboratory and anamnestic confirmation of infection is needed; in the chronic spontaneous form, an autoimmune mechanism is discussed — autoantibodies are found in 45% of such patients.

When to see a doctor

Usually the rash resolves on its own within a few days. An appointment is needed if symptoms do not improve after 2 days, the rash spreads, the wheals return, the temperature rises and the child feels unwell, or swelling appears under the skin. Your concern alone is also sufficient reason.

Urticaria by itself is not a reason to call an ambulance. Call 103 or 112 if the child suddenly has swollen lips, mouth, throat, or tongue; is breathing rapidly or has difficulty breathing, wheezing is heard, or there is a feeling of suffocation; the throat tightens or swallowing is difficult; the skin, tongue, or lips have turned blue, gray, or pale.

This material is for reference and does not replace a doctor's consultation: it helps to understand what is happening and to formulate questions for the appointment.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer