Hives

Hives/Angioedema

Hives, also called urticaria, can be alarming to parents because the rash comes on so fast and can cover a large part of the child’s body, but hives are very common and very safe. 

How can you tell if your rash is hives?

1. The rash comes on fast usually

2. The rash moves, and comes and goes.  Every few hours it will usually look differently!

3. It still feels smooth.  It may be raised, but the skin itself still feels smooth.

4. It blanches.  When you push firmly with your finger into the red area, and then quickly take your finger off, you will see the redness disappear for a very short time, then come back.  That is a good sign of a rash, if it doesn’t blanch, we need to see you ASAP.

What causes hives?

You are trying hard to figure out what caused the hives.  My best advice, unless the hives are recurrent, is to stop trying to figure it out!  We almost never do.  80% of hives are an immune system reaction to a common virus that your immune system is allergic too, which causes releasing of histamine and activating your immune system’s mast cells.  

How long will they last?

50% of people will have their hives less than 1 week, and 75% of people will have their hives less than 2 weeks.  Unfortunately, a minority of people may have them up to six weeks long.

Regardless of how long they last, hives are very safe and are not scary.

How can we treat them?

Topical treatments will do nothing for hives because they come from inside the body, and they move too quickly for a steroid cream to make a difference.  The main treatment for hives is antihistamines.  Benadryl was traditionally used, but can be dangerous and too sedating.  Experts recommend using Zyrtec once daily.  Sometimes if that is not effective we will prescribe hydroxyzine.  Oral steroids are only used for the worst of cases, and typically are not needed.

The goal of treatment is to reduce itch, not to make the rash go away.  Only time will make the rash go away!  If we prescribe hydroxyzine, only use it if you are itching.  

Anything I shouldn’t do with the rash?

Hives are not contagious, so you should do your normal activities.  Some activities can bring the rash out worse temporarily.  Hot showers, exercise, strong emotions, anything that gets your body “worked up” can increase them, but that doesn’t mean you have to avoid those things.