Kids With Hives or Itchy Rash – When Should I Be Worried?

Kids Health Tips: Guide on Rashes & Allergies

Let me tell you about a child who recently visited me at the clinic. The father called me and asked me if I could test for a goji berry allergy as his child had had an itchy rash for 4 days after eating goji berries. I told them to come see me, not because I could do the test, but because I knew it wasn’t a food allergy. Unfortunately, this child had already been given a steroid injection, adrenaline injection, had taken expensive blood tests and been prescribed an Epipen. All for a rash! Let’s discuss this in more detail to help you understand what this means and when to be worried.

Hives are red bumps that can quickly overtake the entire skin. They are extremely itchy and uncomfortable and can appear alarming. As a community, we are used to thinking about hives as an allergic reaction. It is for good reason we think about allergies when we see hives: up to 90% of people experiencing an allergic reaction can have hives, but an allergy is only one possible cause. Most hives are not actually caused by an allergic reaction. This means that when it comes to most cases of hives, we shouldn’t do an allergy test.

What Causes Hives?

If it’s not an allergy, what else can cause hives? The list is endless: stress, viral infections, activity, skin irritation - and sometimes nothing at all. Some people just have a tendency toward developing hives and are not reacting to an external trigger. Imagine a situation where a smoke alarm sounds off no matter what is going on: turning on the kitchen sink, opening the trash can, getting milk out of the fridge. At some point, one would realize these activities are not causing a fire, but the smoke alarm is just going off for no reason. Sometimes, our allergy cells can behave like this over-zealous smoke alarm. 

When should my child have allergy tests?

Hardly ever do I do allergy tests when I see a child with hives. Allergy tests alone do not diagnose food allergy. The story about what happened when the rash started is more important. Being allergic to food means one reacts when they eat that food every time, and it is not defined as a “positive” allergy test. Many children, especially children with eczema, have “positive” allergy tests to foods, yet they eat the food just fine which means they are NOT allergic. 

When children react to a food, the rash normally starts around the face and may spread within 1 hour of eating it. The rash then goes away by the next day as the child stops eating that food. When children react to a food they are eating, they may tell you about an itchy mouth/throat. A younger child who can’t speak might become unhappy, refuse to eat it and may vomit. If a rash happens then it occurs every time they eat the food. Hence hives lasting more than 24 hours is never food allergy.

Should I worry about hives?

Hives are usually nothing to worry about. The first thing to make sure of is that the hives are not a part of an allergic reaction. Usually this is easy to distinguish. If the hives come and go without any rhyme or reason, they are not part of an allergic reaction. Hives that have been going on for longer than a few hours are rarely, if ever, part of an allergic reaction. Hives that come up suddenly while eating something may be an allergic reaction. However, allergic reactions usually also have other symptoms associated with them. Hives in a child otherwise well, breathing ok, active and eating normally is likely not due to allergy.

Hives very rarely signal another problem. However, this is the exception and usually applies to hives that get progressively worse, do not respond to medication and are associated with other symptoms. 

What can I do about hives?

Hives can be very uncomfortable so it is important to try and suppress the hives. The best way to treat hives is by using anti-histamines, which are the same medications used to treat allergies. Sometimes the dose of antihistamines needs to be increased up to four times the usual, but normally, just doubling the dose is sufficient. If your child still has hives, check with your doctor regarding increasing the dose. There are other medicines that can be used to treat hives in the rare times that antihistamines alone are not working. 

The hives can persist for days, even weeks. The main reason for giving antihistamines is to improve quality of life which would be reduced if the child was scratching a lot, especially at night when they can’t sleep. If the rash is mild and the child isn’t bothered, then you don’t necessarily need to treat the rash with medicine unless it gets worse.

The next time you spot some hives on your child, make sure to give them some antihistamines and keep on using the medicine until the hives go away. See your child’s doctor if their hives are not getting better, but keep using the medicine until the appointment.

When to see an allergy specialist?

As I have mentioned, hives are often not serious and if they go away and your child is fine and back to normal, there may be no need to see a specialist at all. However, if your doctor is suggesting avoiding foods or has done a “panel food allergy test”, then to avoid uneccessary food avoidance, an allergy specialist might be a good idea. It is important to realize that if a child from a young age avoids a food type that they are NOT allergic to at that time, persistent avoidance might lead to TRUE allergy in the future.

Need help? Click here to reach out Dr. David, a Consultant Pediatrician at Mediclinic Parkview Hospital, if you want to book a consultation - or call 800 1999.