Hives in Kids: What You Should Know About Common Causes and Treatments

Hives (urticaria) is a common rash that can pop up in kids. And the cause is often quite puzzling. Most of the time these itchy bumps go away quickly with no known cause. But in some cases it may indicate an allergic reaction or a more long-term issue. So it’s important to know when to seek medical attention. 

What causes hives in kids?

Hives are itchy bumps that occur when your body releases histamine. Histamine is part of your immune response to a perceived threat. But, in many cases, the body reacts when there’s no real threat. 

Idiopathic hives in kids means there’s no clear cause or trigger. This is most often the case for hives in children, especially when chronic. Even when you can’t confirm a cause, certain environmental factors can cause the body to release histamine and cause hives. These triggers include:

• Heat 

• Cold

• Stress

• Pressure on the skin   

In some cases there’s a known cause for hives. The most common identified causes of hives in kids are:

• Infection (usually a virus)

• Medication reaction

• Allergic reaction (foods, insects, environment, or medications)

• Anaphylaxis

Infection

Infection is the most commonly identified cause for hives in kids. Viral or bacterial infections can both trigger hives. 

Infections that can often lead to hives include:

• Common cold

• Hepatitis

• Mononucleosis

• Strep throat

• Urinary tract infection (UTI)

Hives related to infection can occur at any time. They can appear at the start of an infection or after the infection has resolved.

Medication

All medications have the potential to cause hives, but some are more likely to cause hives. These include:

• Antibiotics

• Antiepileptics (used to treat seizures)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen

In some cases the cause of hives is an allergic reaction to a medication. In other cases, medications might cause hives due to hypersensitivity reactions. These types of reactions can cause the same symptoms but are not due to an allergy. Your provider can help you figure out if your child is allergic to a medication.

Allergic reaction

Some kids develop hives as part of an allergic reaction to a certain substance. Hives in kids from an allergic reaction develop almost immediately after an exposure. 

Common allergens that trigger hives include:

• Foods (like dairy and nuts)

• Insect bites (like from a bee, spider, or ant)

• Environmental allergies (like pollen, dust, and mold)

• Pets

• Chemicals (like soaps and detergents)

• Medications 

Anaphylaxis

Anaphylaxis is a less common but more severe type of allergic reaction. It’s important to recognize its signs and symptoms because it can be life-threatening. In addition to hives, symptoms of anaphylaxis may include:

• Swelling (angioedema)

• Vomiting

• Difficulty breathing

• Dizziness

Can COVID-19 cause hives in kids?

Yes. The cause of COVID-19 is a respiratory virus. Although it’s mainly a respiratory illness, it can cause many different symptoms — including hives. In children, the rash may appear before fever or other symptoms. COVID-19 can cause several different types of rashes in kids. Notify your healthcare provider if you notice new skin changes in your child. 

What are the symptoms of hives in kids?

Hives in kids can be of different shapes and sizes, just like in adults. The bumps usually appear as a cluster. And they can involve just one area or cover much of the skin. Symptoms of hives include:

• Itch

• Sting

• Warmth of the skin

• Swelling in deeper layers of skin (angioedema)

How long do hives last?

Hives usually go away within 24 hours. But new ones may appear over several days to weeks. If new bumps continue to appear after several weeks, it may be long-term (chronic) hives. In this case, the causes and treatment may be different. 

What is chronic urticaria?

Chronic urticaria is the presence of hives for at least 6 weeks. With this condition, individual bumps may come and go. But there must be some welts present most days of the week. 

There are two types of chronic urticaria:

1. Chronic inducible urticaria: External factors — like heat, cold, vibration, or pressure — trigger these hives.

2. Chronic spontaneous urticaria: There’s no known trigger for these hives. They come and go spontaneously.

How do you treat hives?

In most cases, hives will resolve on their own within a few days. But they can be very itchy and uncomfortable, so treatments to decrease the symptoms can provide some relief. 

You can help reduce your child’s symptoms with the following at-home remedies:

• Over-the-counter (OTC) antihistamines (like cetirizine, loratadine, or fexofenadine) 

• Cool compresses to reduce itch

• Loose cotton clothing to avoid overheating

• Hypoallergenic lotion to keep skin moisturized

• Anti-itch lotions (like calamine)

Treatments are sometimes necessary if your child has chronic hives that keep returning.

Beyond avoiding known triggers, common treatments include:

• Steroids (like prednisone)

• Epinephrine (for severe reactions like anaphylaxis)

• Leukotriene receptor antagonists (like montelukast)

• Antibody therapy (like omalizumab for chronic hives)  

When should you take your child to a provider for hives?

You can manage most cases of hives at home. But if your child's symptoms are severe or don’t go away, it’s a good idea to visit a provider. If the hives last more than 6 weeks, they may recommend a referral to an allergy specialist or dermatologist. 

If your child develops any of the following symptoms, you should seek emergent medical care:

• Swelling of the lips or tongue

• Swelling or tingling of the mouth or throat

• Difficulty swallowing

• Difficulty breathing

• Vomiting

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Written by:

Louisa Salisbury, MD

Louisa Salisbury, MD, is a licensed, board-certified general pediatrician. She received a bachelor’s degree in human development from the University of California, San Diego, and obtained her medical degree from the University of Vermont Robert Larner College of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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