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  • Hives

    Definition

    • An itchy rash made up of raised pink bumps with pale centers
    • Most often, rash is very itchy

    First Aid Advice for Anaphylaxis – Epinephrine

    • Anaphylaxis is a life-threatening allergic reaction.
    • If you have epinephrine (such as Epi-pen), give it now.
    • Do this while calling 911.
    • Over 66 pounds (30 kg): Give 0.3 mg. Epi-Pen.
    • 33-66 pound (15-30 kg): Give 0.15 mg. Epi-Pen Jr.
    • Less than 33 pounds (15 kg): Give dose advised by your doctor.
    • Give the shot into the upper outer thigh in the leg straight down.
    • Can be given through clothing if needed.
    • Benadryl: After giving the Epi-pen, give Benadryl by mouth. Do this if your child is able to swallow.

    Symptoms

    • Raised pink bumps with pale centers (welts)
    • Hives look like mosquito bites
    • Sizes of hives vary from 1 inch (12 mm) to several inches (cm) across
    • Shapes and location of hives can be different. They can also change frequently.
    • Itchy rash

    Causes

    • Hives all over the body are most often caused by a viral infection. Can also be an allergic reaction to a food, drug, or insect bite. Often, the cause is not found. Hives from foods usually resolve in 6 hours.
    • Hives just in one spot are usually due to skin contact with an irritant. Examples are plants, pollen, food or pet saliva. Localized hives are not caused by drugs, infections or swallowed foods.

    When to Call Us for Hives

    Call 911 Now (your child may need an ambulance) If:

    • Hives and life-threatening allergic reaction to similar substance in the past. (see FIRST AID)
    • Trouble breathing or wheezing
    • Hoarse voice or cough start suddenly
    • Trouble swallowing, drooling or slurred speech start suddenly
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Your child looks or acts very sick
    • Hives start after a bee sting or high-risk food. High-risk foods include nuts, fish, shellfish, milk, or eggs.
    • Hives started after taking a prescription medicine
    • Age under 1 year with hives all over
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Hives started after taking an over-the-counter medicine
    • Severe hives (such as eyes swollen shut or very itchy)
    • Fever or joint swelling is present
    • Stomach pain or vomiting is present

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • Hives make it hard to go to school or do other normal activities. (Note: Taking Benadryl for 24 hours has not helped.)
    • Food could be the cause
    • Had hives 3 or more times and the cause is not clear
    • Hives last more than 1 week

    Parent Care at Home If:

    • Hives with no complications

    Care Advice for Hives

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

    • 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.
    • Often the cause is not found.
    • Most hives don’t turn into a severe allergic reaction.
    • Here is some care advice that should help.

    Benadryl for Hives All Over the Body:

    • Give Benadryl 4 times per day for hives all over that itch. No prescription is needed. See Dose Table.
    • If you only have another allergy medicine at home (but not Benadryl), use that.
    • Continue the Benadryl 4 times per day until the hives are gone for 12 hours.
    • Caution: Do not use if age is under 1 year. Reason: Benadryl is a sedative. Give your doctor a call for advice.

    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.

    Get Rid of Allergens:

    • 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
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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