Pediatric Urticaria: Skin Emergencies Beyond Allergies

     Many families are startled awake by a child’s crying, only to find red, itchy, and swollen patches across their limbs or body. Parents often immediately suspect "Urticaria", as it is common in children. However, many mistake the symptoms for the underlying cause, which can lead to improper care and treatment.

But if we understand the origins and know how to handle them correctly, those anxieties will fade away.

Urticaria (Hives) in Children

Urticaria (Hives) is a condition that causes hives, triggered by various factors. It is categorized into 2 types:

• Acute Urticaria: Lasts no longer than 6 weeks, which can result from food allergies, medication, or infections. Mostly, the child might have a viral or bacterial infection, and hives appear as a symptom when the child is ill, such as a respiratory tract infection.
• Chronic Urticaria: If symptoms persist longer than 6 weeks, it may fall under chronic urticaria. The cause is often unclear, possibly due to the immune system being oversensitive to triggers.

How does a ‘Hives Rash’ differ from ‘Urticaria Disease’?

These two terms have overlapping meanings but are not the same.

• Hives Rash is the “clinical manifestation” on the skin, appearing as swollen, red, raised patches of varying sizes. They may look like mosquito or ant bites and, importantly, are usually very itchy. This type of rash is unique in that it “keeps moving around” and typically fades away on its own within 24 hours without leaving a mark.

4 Warning Signs Parents Should Not Ignore

• Chest tightness, difficulty breathing, or wheezing.
• Severe swelling in soft tissue areas such as eyelids, lips, or tongue (Angioedema).
• Abdominal pain, nausea, or vomiting.
• Drowsiness, cold extremities, or loss of consciousness due to low blood pressure.

‘Food Allergy’ is not the only cause of hives

     Many cases of hives in Thai children are not always caused by food allergies, but may stem from "physical factors" such as friction-induced hives or Cold Urticaria (Hives from cold) when taking a cold bath or staying in an air-conditioned room. Therefore, you should not quickly apply ice to the hives because if the child has cold urticaria, the rash will flare up even more. If we do not find the true cause, treatment may only be addressing the symptoms.

Why consult a Pediatric Dermatologist?

     While taking antihistamines can help relieve initial symptoms, the key to treatment is "reading the lesions." A pediatric dermatologist will carefully observe the red patches to distinguish them from more severe conditions that look similar, such as Vasculitis (inflammation of the blood vessels), where the rash may resemble hives but does not disappear on its own or may have a purplish tint. This requires specialized experience for diagnosis.

Care and Prevention for Children with Hives

     Parents should prevent their children from scratching the skin, as it could lead to secondary infections. Use fragrance-free body lotions and dermo-cosmetics that strengthen the skin barrier (Ceramide) to reduce skin sensitivity.

Providing the Most Comprehensive Care Together

     Ramkhamhaeng Hospital prioritizes holistic care. If a diagnosis finds that the hives are related to a complex immune system or pose a risk of severe allergic reaction (Anaphylaxis), we will work in coordination with Pediatric Allergists and Pediatric Infectious Disease Specialists to investigate down to the cellular level and specific allergens, ensuring parents are confident that their child is protected both externally and internally.

Providing care from the very first minute the disease occurs brings peace of mind to all of us as parents. Seeing a child recover and smile happily is the highest aspiration for me as a doctor as well.

Bibliography

Kanokvalai Kulthanan. (2009). Urticaria. Bangkok: Moh-Chao-Ban Publishing.

Penpun Wattanakrai. (n.d.). Urticaria. Retrieved February 2, 2026, from

https://www.rama.mahidol.ac.th/med/sites/default/files/public/pdf/medicinebook1/URTICARIA.pdf