Urticaria, known as hives in the community, is a sudden onset, skin rash, blistering, itching and swelling called angioedema. It’s common on all body. Many factors can lead to hives, primarily infections, nutrients, and medications. It usually resolves spontaneously after a few days.

What is Urticaria (Hives)?

Urticaria is a pink or red color that occurs on the upper layers of the skin and fades with pressing. The urticaria findings are caused by the expansion of the veins just under the skin and some fluid leaking from the veins.

Urticaria is classified as acute and chronic urticaria depending on its time. If the rash lasted more than 6 weeks, it is called chronic. Chronic urticaria are divided into two as spontaneous and physical (inducible) urticaria. If it occurs with any physical stimulus such as cold, hot, vibration, sunlight, scratching the skin, it is called physical (inducible) urticaria. 

What is the incidence of urticaria (hives)?

Urticaria can be seen at any age and occurs in about one in five people for life. Chronic urticaria is less common in children than in adults. Frequency of it being seen a lifetime is about 0.5-5%.

What are the symptoms of urticaria (hives)?

The signs of urticaria are fluffy pink-red rashes of skin of various shapes and sizes that can be seen all over the body, which start suddenly. Small rashes can merge over time to make large plaques. They fade by pressing. Rashes are often itchy. Depending on the cause of the disease, it can sometimes be in the form of small spot rashes that collect water on it or resemble scarlet fever. It is the most important feature that the rashes disappear without a trace within 24 hours at the latest. The swelling called angioedema seen with hives is often seen around the eyes and lips, where the supportive connective tissue is loose. The disease is mostly seen as hives alone or hives with angioedema. At small ratio it can be seen as only angioedema.

What are the causes of urticaria (hives)?

The most common cause of acute urticaria in childhood is infections. Other important causes are food and drug allergies. Respiratory allergens and insect stings can also cause urticaria. Infections that cause urticaria are usually viral upper respiratory infections. But other infections can also cause urticaria. Among the drugs, antipyretic-pain medications called penicillin group antibiotics and non-steroidal anti-inflammatory agents cause urticaria. Generally, food allergies are considered the most common cause, but they cause less urticaria. The most common causes of food are milk, eggs, nuts and seafood. Nutritional additives may also cause. However, the cause cannot be determined in a significant number of patients. 

The cause is even more difficult to detect in chronic urticaria. In approximately half of the cases, autoimmune creates an allergic reaction by the body itself.

As mentioned above, various physical stimuli can also cause urticaria. Stress and exercise can also trigger urticaria.

When to see a doctor for urticaria (hives)?

Families do not care for hives especially in mild cases and do not go to the doctor or come to the doctor with extreme fear, considering that it is a dangerous situation when it is a bit severe. The two approaches are often not true. If the urticaria symptoms are severe and there are signs of swelling in the tongue and throat in addition to the skin findings, urgent medical attention should be sought. Although the findings of the patients are mild, it would be appropriate to evaluate the underlying cause and, if possible, to prevent their recurrence or to determine whether there are any diseases that are confused with urticaria. In addition, patients with prolonged, frequent or chronic hives should be evaluated by child allergists who are experienced and informed in this regard.

What to do before going to doctor for urticaria (hives)?

Examination and evaluation will be more useful if you prepare on the issues we have mentioned below before coming to the examination.

  • Note when the findings began and, if recovered, how many days they continued.
  • Make a list of all the drugs you use or bring them with you
  • Bring with you any previous blood tests and x-rays.
  • Note the questions about the disease you are asking the doctor about
  • If an allergy test is required to detect any underlying allergic cause, discontinue allergy syrups and pills, cold medications and cough syrups 1 week in advance, as it affects the test result.

How is Urticaria Diagnosed?

A detailed history and examination should be done in the hives for diagnosis. First, it is necessary to understand whether this condition is acute or chronic. It is easier to identify the underlying cause in acute urticaria. Therefore, it is not recommended to conduct too many examinations. If any allergen is suspected to cause hives, in this case, allergen tests can be made from blood or skin and that allergen can be detected.

Although chronic urticaria is less common in children, it is necessary to conduct a more detailed examination, as it may be the case of serious diseases underlying it. If the body is thought to be allergic to itself, an autologous serum test is performed to demonstrate that condition.

If any physical (inducible) urticaria is thought to be, specific tests can be done for that trigger. In order for these tests to be carried out in a safe and correct manner, they should be performed under the supervision of experienced pediatric allergists.

How is Urticaria Treated in Children?

The first thing to do in the treatment of acute urticaria is to eliminate it if any cause is found. If the reason is a food, it should be discontinued, and if it is a bacterial infection, it should be treated with antibiotics.

Various medications are used to eliminate the patient’s complaints. Allergy pills and syrups must be given first. If the standard dose is not enough, it can be increased up to 4 times. In cases of severe and in situation where allergic drugs are no use, short-term cortisone can be used by mouth. 

If the symptoms of urticaria have appeared in physical (inducible) urticaria despite avoiding that stimulant, allergy medications should be used.

Treatment is more difficult in chronic urticaria. In addition to the above medicines, drugs affecting the immune system, and if patient is more than 12 years old, the drug called Anti-IgE (oma) can be used. These patients should be followed up by pediatric allergy specialists and appropriate treatments should be performed.

Is there an emergency treatment situation?

If the signs of urticaria are severe when they first start and there are other findings besides the skin findings, the patient should be taken to an emergency room immediately and an adrenaline may be needed, as in the treatment of anaphylaxis, as there is a possibility of developing anaphylaxis (allergic shock).

Why Urticaria (Hives) Is Important?

Urticaria (hives) is a disease that often resolves spontaneously. But acute urticaria may initially be the first sign of a systemic severe allergic reaction and may be life-threatening. If there are any allergens causing hives, similar scenes can be seen later. In chronic urticaria, an important disease may lie under. Urticaria may have appeared as a result of this disease. If left untreated, it can lead to dangerous consequences.

Therefore, evaluation and monitoring of children with urticaria by pediatric allergy doctors will be beneficial.

As a result;

  • Urticaria (hives) is a sudden onset disease with a rash, bulging, itching and swelling called angioedema.
  • It is divided into acute and chronic. If it lasts longer than 6 weeks, it is considered chronic.
  • The most common causes of acute urticaria are infections, nutrients, and medications.
  • The biggest reason in chronic urticaria is that the body allergies itself.
  • Urticaria (hives) diagnosis is made through history, examination and allergy tests and various tests.
  • If there is any factor in the treatment of urticaria (hives), it is removed, as a medicine, allergy syrup or pills and in severe cases, short term cortisone is used.
  • In chronic urticaria, other drugs can be used when necessary.
  • Since both acute and chronic urticaria can create conditions that endanger the child’s health for a variety of reasons, it will be beneficial to be examined and treated and monitored by pediatric allergy specialists when necessary.

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