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Hives

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Definition

An itchy rash made up of raised pink bumps
Most often, rash is very itchy

Symptoms of Hives

Raised pink bumps with pale centers (welts)
Hives look like mosquito bites
Sizes of hives vary from ½ inch (12 mm) to several inches (cm) across
Shapes and location of hives can be different. They can also change often.
Itchy rash

Causes of Widespread Hives

Viral Infection. The most common cause of hives all over the body is viral infections. Research has confirmed this. Other symptoms such as a fever, cough or diarrhea are also present. The hives may last 3 days. This is not an allergy.
Bacterial Infection. Some bacterial infections can also cause hives. A common example is Strep. Hives are also seen with bladder infections. (UTIs)
Drug Reaction. An example is a penicillin rash. Most rashes that start while taking an antibiotic are viral rashes. Allergy tests are normal 90% of the time. Only 10% turn out to be a drug allergy.
Food Reaction. May be an allergy or a coincidence. If the food is a high risk one (such as peanuts), consult an allergist. Hives from foods usually resolve in 6 hours. Hives from infections last for days. Only 3% of hives are due to a food.
Bee Sting. Widespread hives after a sting may be part of a serious allergic reaction. Need to consult an allergist.
Anaphylactic Reaction (Very Serious). The sudden onset of hives with trouble breathing or swallowing. This is a severe allergic reaction to an allergic food or drug. Most often begins within 30 minutes of swallowing the substance. Always within 2 hours of exposure.
Unknown. Over 30% of the time, the cause of hives is not found.

Causes of Localized Hives

Irritants. Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy.
Plants. Many plants cause skin reactions. Sap from evergreens can cause local hives.
Pollen. Playing in the grass can cause hives on exposed skin.
Pet Saliva. Some people get hives where a dog or cat has licked them.
Food. Some children get hives if a food is rubbed on the skin. An example could be a fresh fruit. Some babies get hives around their mouth from drooling a new food.
Insect Bite. Local hives are a reaction to the insect's saliva. Can be very large without being an allergy.
Bee Sting. This is a reaction to the bee's venom. Can be very large without being an allergy.
Localized hives are not caused by drugs, infections or swallowed foods. These get into the bloodstream and cause widespread hives.

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Care Advice

Hives Only on One Part of the Body - What You Should Know:

Most are caused by skin contact with an irritant. Examples are plants, pollen, food or pet
saliva.
Localized hives are not caused by drugs, infections or swallowed foods. They are also not an allergy.
Wash the allergic substance off the skin with soap and water.
If itchy, use a cold pack for 20 minutes. You can also rub the hives with an ice cube for 10 minutes.
Hives just on one part of the body should go away on their own. They don't need Benadryl.
They should go away in a few hours.

Hives All Over the Body - What You Should Know:

Over 10% of children get hives 1 or more times.
Most widespread hives are caused by a viral infection. This is not due to an allergy. Less than 10% are an allergic reaction to a food, drug, or insect bite. Often, the cause is not found.
Here is some care advice that should help.

Allergy Medicine for Hives All Over the Body:

Give Benadryl 4 times per day for hives all over that itch. Age limit: 1 and older.
Use an allergy medicine until the hives are gone for 12 hours.
If the hives last more than a few days, switch to a long-acting antihistamine, such as Zyrtec. No prescription is needed. Age limit: 6 months and older.

Zyrtec dosing for 6 months to 2 years: 2.5 mL (2.5 mg) every 24 hours.
Zyrtec dosing for 2 years and older: follow package directions.

Hives Caused by Foods:

Foods can cause widespread hives.
Sometimes, the hives are just around the mouth.
Hives from foods usually last just a short time. They often are gone in less than 6 hours.

Cool Bath for Itching:

To help with the itching, give a cool bath. Do this for 10 minutes. Caution: avoid causing a chill.
Can also rub very itchy spots with an ice cube for 10 minutes.

Wash Allergens Off Body:

Give a bath or shower if caused by pollens or animal contact.
Change clothes.

Stay Away from Allergens:

If you know what is causing the hives, avoid this substance. An example is certain foods.
Help your child stay away from this allergen in the future.

Return to School:

Hives cannot be spread to others.
Your child can go back to school once feeling better. The hives shouldn't keep him from normal activities.
For hives from an infection, can go back after the fever is gone. Your child should feel well enough to join in normal activities.

What to Expect:

Hives all over from a viral illness normally come and go.
They may last for 3 or 4 days. Then, they go away.
Most children get hives once.

Call Your Doctor If:

Severe hives not better after 2 doses of Benadryl
Itch not better after 24 hours on Benadryl
Hives last more than 1 week
You think your child needs to be seen
Your child becomes worse

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Barton Schmitt MD, FAAP

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.

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