Caring for a Child with Chronic Hives

Chronic hives are red and itchy patches of skin that last for longer than 6 weeks. They cannot spread to other people. A single spot of hives may last for only 24 hours. Most children with hives can be treated with antihistamines. Helping them avoid triggers and giving anti-itch treatments at home can also help.1,2

For most children, chronic hives last less than a year. They almost always go away within 5 years. But the physical and emotional burden can be significant during that time. Your child may need help learning how to cope with the effects of chronic hives on their daily life.1-3

What do chronic hives look like in children?

Symptoms of chronic hives look similar in children as in adults. The main symptom is red blotches or welts that appear on the skin. The hives are not contagious. Hives come and go for months or years, but an individual wheal may appear and disappear within 24 hours.1

Like adults, children may get hives in response to a certain trigger. Some common triggers include allergens, infections, and extreme temperatures. It is more common for hives to be related to food allergies in kids than in adults. Children are more likely to need allergy testing during diagnosis.2

Chronic hives can affect your child’s school performance and social life. Other kids or parents may mistakenly think the hives are contagious. This social stigma can cause your child to feel embarrassed or isolated. Pain and itchiness can also distract your child during the school day. These factors can combine to affect your child’s overall well-being and performance in school.3

How can I treat my child at home?

Most children with chronic hives can be treated at home. The goal of at-home treatment is to reduce itchiness and discomfort. Many children respond well to over-the-counter antihistamines. These drugs prevent a chemical called histamine from causing itchy hives. Non-drowsy antihistamines approved for children include:2,3

  • Cetirizine (Aller-Tec®, Alleroff, Zyrtec®)
  • Loratadine (Alavert®, Claritin®)
  • Fexofenadine (Allegra®)
  • Levocetirizine (Xyzal®)
  • Desloratadine (Clarinex®)

Some of these drugs are not recommended for children under age 4. Do not give your child a dose without first talking to your child’s doctor.

Antihistamines should be taken only as prescribed. Be sure to follow the doctor’s order. The best dose and type of antihistamine varies for everyone. About half of all chronic hives go away within 1 year. It may help your child to know that they will not likely have to take antihistamines forever.3

Your doctor can suggest which antihistamines to try and how to use them. They can also suggest medicines to try if antihistamines do not control symptoms. For example, children over age 12 may benefit from omalizumab (Xolair®).2,3

What else can I do to help my child?

There are many things you can do to help your child reduce the burden of chronic hives. Some at-home techniques and lifestyle changes that may help include:1,2

  • Helping your child learn as much as possible about the condition and treatments
  • Reducing scratching by covering hives with clothing
  • Using a cold washcloth or cold pack on the hives to reduce itchiness, unless cold is a trigger
  • Bathing in cool or lukewarm water with colloidal oatmeal
  • Avoiding getting overheated
  • Adjusting the temperature in your house
  • Using moisturizer or anti-itch creams recommended by your child’s doctor
  • Helping to identify triggers by starting a symptom diary, which your child can help with

You can also help your child cope with the emotional and social impacts of chronic hives. Some things you can do to prevent feelings of embarrassment and isolation include:2

  • Talking to school employees or other parents about how chronic hives affect your child
  • Having your child regularly talk to school counselors or therapists
  • Finding a support group for your child to join

When does my child need emergency care?

Hives are usually not life-threatening for children. It is natural to worry if you see hives on your child. The welts can be very large and red, which can be scary. However, chronic hives rarely need emergency care.2

In general, chronic hives do not lead to serious, life-threatening allergic reactions. However, a short-term allergic reaction can cause hives. This type of allergic reaction can also cause trouble breathing. This can happen when angioedema (swelling) of the airways blocks breathing. A severe, life-threatening allergic reaction is called anaphylaxis. Symptoms of anaphylaxis include:1,2

  • Difficulty breathing
  • Dizziness
  • Fainting
  • Nausea and vomiting
  • Diarrhea
  • Rapid heartbeat

If you notice any of these symptoms, get emergency care as soon as possible. At the hospital, your child may receive an epinephrine injection. Doctors can then give you further info on treating anaphylaxis at home. While it is important to recognize the signs of life-threatening allergic reactions, chronic hives do not generally lead to this type of reaction.1

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Written by Matt Zajac │ Last reviewed: April 2022