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Urticaria in children: photo, symptoms, treatment


One of the most pressing problems of modern pediatric practice is urticaria , which occurs in 2.1-6.7% of children and adolescents. According to statistics, the peak incidence occurs at the age of 14-40 years, but at the moment there are more cases of characteristic rashes in toddlers and preschool children. What does urticaria look like in the photo? What are the symptoms of urticaria and how to treat it? You will find answers to these and other questions below.

What is urticaria?

Urticaria is a collective name that includes a group of heterogeneous pathologies characterized by the appearance of a diffuse or limited rash with a primary morphological element papule (an itchy blister of various sizes). It is a limited swelling of the dermal layer of the skin with a characteristic hyperemia on the periphery and a more pale central area. Dimensions of edema in diameter can vary from several mm to several cm. This formation is temporary, that is, it can disappear during the day. In case of swelling spreading to the deeper dermal layers, subcutaneous tissue and mucous membrane, aponeurotic swelling ( angioedema ) is formed.

Urticaria in children photo According to the duration of the course of the disease, urticaria is divided into acute and chronic. The duration of the acute form, characterized by spontaneous development, is not more than 1.5 months. In the event that the rash in a child persists for more than 6 weeks, chronic urticaria is diagnosed.

Clinical forms of urticaria:

  • spontaneous;
  • physical (arising under the influence of external factors);
  • contact

Classification according to the nomenclature of allergic diseases

  1. Allergic (IgE-mediated) urticaria.
  2. Non-allergic (non-IgE-mediated) urticaria.

Urticaria in children is most often acute, may be an independent pathology, or a symptom of another disease.

Causes of urticaria in children

Factors triggering the development of acute urticaria:

  • Food (seafood, nuts, citrus, fruit, food additives, etc.);
  • Hymenoptera poison;
  • Toxins of stinging and poisonous plants;
  • Viral infections;
  • Intolerance of some drugs, radiopaque substances and blood components.

Causes of chronic urticaria:

  • Environmental factors (water, wind, cold air, insolation, vibration, external pressure, etc.);
  • Autoimmune pathology (collagenosis);
  • Worm invasions;
  • Endocrine pathologies;
  • Allergic diseases ( atopic dermatitis , bronchial asthma, pollinosis);
  • Chronic bacterial, fungal and viral infections.

The mechanism of development of urticaria is associated with activation of mast cells in the skin and the release of the cytoplasmic granules contained in them (degranulation) into the surrounding tissues. Part of the histamine granules (inflammatory mediator) causes the development of clinical symptoms of the disease.

Symptoms of urticaria in children

Urticaria in children photo symptoms treatment Urticaria is a disease in which skin rashes are localized on any part of the body, including the soles, palms and scalp. It should be emphasized that the greatest number of fat cells is in the head and neck, and therefore the itch is characterized by the greatest intensity.

As a rule, the disease in children begins suddenly. Initially, severe itching occurs in various areas of the skin, and then blisters begin to form. How they look you see in the photo. Papules can be formed not only on the skin, but also on the mucous membranes. Often the rash is accompanied by swelling of the lips, eyelids, limbs and even joints. Just like blisters, the swelling can persist for up to a day (from a few minutes), but at the same time, it can sometimes linger for up to 48-72 hours.

The most serious and risky condition is the formation of angioedema (angioedema), which some clinicians call the giant urticaria. This condition is accompanied by a deeper swelling of the dermis and subcutaneous loose tissue. The greatest danger is the swelling of the mucous membrane of the respiratory tract. Its characteristic symptoms include difficulty with wheezing, breathing, cyanosis (cyanosis) of the nasolabial triangle, and paroxysmal strong cough. In such a situation, the child requires urgent medical care, since in the absence of adequate therapeutic measures, a fatal outcome is possible.

If angioedema affects the mucosa of the digestive tract, the patient appears nausea, persistent vomiting, short-term diarrhea is possible. With damage to the inner ear and meninges, headache, dizziness, inhibition of reactions, nausea and vomiting develop.

The acute form of the disease is accompanied by a rise in body temperature of up to 38–39 ° C, malaise, and headache. Sometimes the development of angioedema is possible. If, if the recommended diet is followed and other medical recommendations are followed, the child’s skin rash does not go away, chronic urticaria is diagnosed. This condition, which occurs with periods of exacerbations and remissions, can lead to chronic dermatitis upon the accession of a secondary infection.

Diagnosis of urticaria in children

Diagnostic study includes the following activities:

  1. History taking (finding out the reason that provoked the development of the disease and clarifying the family history of allergic diseases);
  2. Physical examination (assessment of the nature of the rash, localization and size of papules). Also during the consultation, the patient’s subjective sensations, the time of disappearance of the blisters and the possible presence of pigmentation at the site of the rash are clarified.
  3. Evaluation of disease activity. It is produced using a specially developed Urticaria Activity Score.
  4. Laboratory studies required to determine the cause of skin lesions (clinical blood and urine tests, tests with autologous blood serum and with atopic allergens, liver enzymes, the level of total immunoglobulin, fibrinogen, eosinophilic cationic protein, etc.).

To confirm the diagnosis of "cholinergic urticaria" that occurs on the background of elevated body temperature, a test with dynamic physical exertion (provocative test) is carried out;

  • dermographism confirmed by mechanical irritation of the skin;
  • solar urticaria - photo testing;
  • aqua urticaria - the imposition of a water compress (+25 C);
  • cold urticaria confirmed by Duncan-test (ice cube on the wrist);
  • delayed urticaria, occurring 6–8 hours after vertical pressure on the skin, with a dough with hanging the load;
  1. If necessary, to determine the causes that provoked the occurrence of skin rashes, it is recommended to undergo an extensive examination (to detect parasitic, bacterial, fungal or viral infection, endocrine or autoimmune pathology).
  2. Additional diagnostic studies: ultrasound of internal organs, X-ray of the chest and paranasal sinuses, ECG, endoscopy.

If during the diagnostic examination it was not possible to identify the cause of the disease, the urticaria is considered idiopathic.

First aid for urticaria

As a rule, with the acute form of urticaria, skin rashes disappear on their own after a few hours or 1-2 days, without any help. However, in this situation, the main problem is not the rash, but the itching it causes. Therefore, when providing first aid, the efforts of parents should be directed to its elimination.

  1. First of all, it is necessary to prevent the action of an irritating factor (it may be food, a drug or a pet). Further, to reduce itching, it is recommended to apply a non-hormonal antiallergic cream, approved for use in children from a very early age (Fenistil, Gistan, Skin Cap, Elidel, Potopik, Desitin, etc.). In the absence of medication, you can use a sunburn cream, which also relieves itching, or apply a cool compress to the affected skin area (1 tablespoon of vinegar per 250 ml of water).
  1. In the presence of rashes, it is necessary to constantly ensure that the child does not comb the skin, in order to avoid scratching, shortly cut the nails. Cotton clothes will also help reduce the intensity of itching and irritation.
  1. In the case of the development of edema and other negative symptoms (nausea, vomiting, increased heart rate, respiratory failure, cold sticky sweat, fainting), an ambulance team should be urgently called.
  1. Before the arrival of “Ambulance”, after discontinuing contact with the allergen, provide the child with abundant drinking (preferably mineral alkaline water or alkaline solution prepared at home (1 g baking soda per 1 liter of water)) and give an enterosorbent (drug for binding and removing the allergen from the digestive tract). In the event that angioedema occurs after an insect bite or injection, it is necessary to bandage the place above the bite or injection site.

Treatment of urticaria in children

When choosing a treatment strategy, the causes and forms of the disease are primarily taken into account. The basic principles of therapy used in clinical practice in dealing with urticaria in children include elimination (excluding or limiting the effect of provoking factors), taking medications, and treating pathologies that can cause skin rashes.

As drugs of basic therapy, antihistamine tablets are used, which stop the symptoms of acute urticaria. In severe cases, patients are shown parenteral administration of classical fat-soluble first-generation antihistamines and glucocorticosteroids.

To date, pediatricians rarely prescribe first-generation antihistamines to their patients, preferring more modern histamine receptor blockers. This is due to the fact that even short-term use of classical antihistamines can lead to the development of side effects (dryness of the oral mucosa, increased sputum viscosity in children with asthma, increased intraocular pressure, impaired psychomotor and cognitive functions, constipation, urinary retention and so on. ). At the same time, antihistamines of the II generation are characterized by the absence of side effects, have a high level of safety and are quite convenient to use.

If the urticaria was provoked by food, along with the use of agents that suppress the action of free histamine, the child is prescribed sorbents for cleaning the intestines (Enterosgel, Laktofiltrum, Smektu, etc.).

Treatment of idiopathic urticaria provides for strict adherence to a hypoallergenic diet and the use of medications recommended for the treatment of other types of acute urticaria. When carrying out intoxication therapy, the child is assigned soft sorbents, Hemodez (drip), and, if necessary, digestive enzymes. In parallel, symptomatic treatment is carried out.

Children suffering from the chronic form of urticaria, need long-term frequent use of drugs that suppress the action of free histamine.

With a severe course of chronic autoimmune urticaria, a sick child requires hospitalization. In this case, the treatment involves plasmapheresis (the method of extracorporeal hemacorrection, based on the removal of part of the circulating plasma, together with functional antibodies to immunoglobulins of class E). With resistance to traditional therapy, intravenous administration of immunoglobulin activates T-suppressors and cyclosporin A, suppressing mast cell degranulation.

Hypoallergenic diet with urticaria in children (by AD Ado)

Prohibited Products

How to treat hives in children

  • Seafood;
  • Chocolate;
  • Products with flavors, preservatives and artificial food additives;
  • Smoked meat;
  • Fish dishes;
  • Condiments and spices (mustard, vinegar, mayonnaise, etc.);
  • Spices;
  • Eggs;
  • Honey;
  • Pastry baking;
  • Poultry meat;
  • Mushrooms;
  • Eggplant, tomatoes;
  • Citrus;
  • Strawberries and strawberries;
  • Nuts (almonds, peanuts);
  • Coffee.

Permitted Products

  • Vegetable and cereal soups (on vegetable or beef broth);
  • Boiled beef;
  • Boiled potatoes;
  • Oil (butter, olive, sunflower);
  • Kashi (buckwheat, rice, oatmeal);
  • Fresh cucumbers;
  • Parsley dill;
  • Day-old dairy products (cottage cheese, yogurt);
  • White bread (no muffin);
  • Sugar;
  • Compotes (cherry, apple, plum, currant, from dried fruits);
  • Apples (baked);
  • Tea.

Diet with urticaria, provoked by food

If the cause of the urticaria is a food allergen, it is recommended to follow fasting within 3-5 days. In parallel, they carry out bowel cleansing with cleansing enemas. Before fasting, a single dose of a laxative prescribed by a doctor is possible. The average daily fluid requirement in this period is 1.5 liters.

At the end of fasting, the following child nutritional scheme is developed:

the first two days the patient is given on an empty stomach 100 grams of one type of product, and then another 200 grams 4 times a day. Every 2-3 days, a new (“clean”) product is added to the previously prescribed one.

For example, in the first 2 days - boiled potatoes, then some other boiled vegetable is added to it, then milk, then bread, beef, etc. Lastly, the child is injected with the product that most likely , could trigger the appearance of rashes. The appearance of papular rash after eating one of the studied products confirms its role in the development of an allergic reaction. On this day, the child is shown hunger and cleansing enemas without the use of drugs. In the next 2 days it is allowed to use only previously tested products.

Through elimination diets for each particular patient creates their basic diet, including basic foods. It is mandatory for parents to keep a food diary, which will display the state of the child before and after meals, as well as after the introduction of a new food product.

Alternative diet for urticaria

In the event that skin rashes appear while taking aspirin or NSAIDs (drug urticaria), the treatment primarily involves the abolition of these drugs. However, at the same time, foods containing natural salicylates (raspberries, strawberries, cherries, grapes, apricots, apples, peaches, cucumbers, tomatoes, potatoes, carrots) should be excluded from the diet, as well as foods with food additives. (E102, E210.212, E320.321).

When physical urticaria to reduce inflammation is recommended to reduce the consumption of salt (including dishes containing it).

Prevention of acute urticaria in children

  • Complete elimination of contact with the allergen;
  • conducting supportive courses of allergen-specific immunotherapy;
  • compliance with an elimination diet and exclusion from the child's diet of foods that cause the appearance of skin rashes;
  • rejection of the use of drugs that trigger the development of allergic reactions;
  • timely treatment of pathologies of the nervous system and the digestive tract.

| 2 February 2015 | | 2 114 | Children's diseases
Leave your feedback

Khalid Binili: I've been investigating reducing hives naturally and found an awesome website at Avyan Hives Plan (google it if you are interested)

Jinx YT: I think I have aquagenic urticaria Edit: This morning when I got out the bath I had hives all over my body and when I drank a cup of water at breakfast my throat started swelling and it became hard to breathe and I had these weird bumps on by tounge

ChessGuru: Get your doctor to prescribe you Hydroxysine 25mg here in UK they come in a box of 28 tablest. They certainly worked for me. This is in case of Hives / Urticaria.


Onna Diy It: i also have cold urticaria, the first i noticed is when i was in a pool(i was around 5 or 6yrs old), once i got out i was covered in hives and i was red and super itchy, me and my mom thought that its was the chlorine in the pool that made me break out but about maybe a month later around (February it gets even colder in Wisconsin) the same thing had happend so we went to the ER and even the doctors didn't believe nor know what was happening! even when i am at the pool on a hot day when the wind blows i get cold and the hives and itchiness starts happening, and when i do the dishes and my wrist get wet then i don't wipe them off they start to get itchy and i get hives on them. i don't have it as severe to the point where i cant eat ice cream or drink cold drinks but i still do get hives pretty bad. i remember when ever it was cold in a class room and they had like mettle chairs, the chair would be cold and i would get hives on my bottom and it would itch like crazy because i would sit there for 2 hours (eventually i started sitting on sweaters). i also remember when my summer camp went to the local pool it was a little chilly that day and i was swimming and then my arms and behind my knee was itching soooo bad i had to get out and go find my "teacher/head of my group" and one of the "teachers" had to take me home early i was so embarrassed when i got out of the pool because everyone was staring at my arms and legs because they were so red and bumpy. -last thing- even when i go trick or treating in October i get hives on my neck and my face, sometimes they get close to my eye and i see a bump at the bottom of my eye. anyway i just wanted to share my story, if you have any questions feel free to ask xoxo

Daniel Trevino: I got hives because I ate pizza and I must've been allergic to an ingredient :p not gonna say what pizza brand for... reasons.

Neelamanigandan Manigandan: Hi greetings from India, my toddler having this symptoms and we consulted pediatrician here. They said it's urticaria and we cannot do anything with it. Can we have any remedies for this at this very young. So that I can be a permanently cured...

Blaise Kiriku: There are several things for lessening urticaria Ensure you eat enough fruit and vegetables. Take vitamin C Use herbs which cleanse the liver including milk thistle Use herbs with infection fighting properties including myrrh and burdock and others including echinacea (I read these and why they work on Avyan hives plan website )