Health Resources

Hives

Main Symptoms

• Raised pink bumps with pale centers (welts)
• Hives look like mosquito bites
• Sizes of hives vary from ½ inch to several inches across
• Shapes of hives are also quite variable
• Location, size, and shape change rapidly and repeatedly
• Itchy rash
• Main Cause: reaction to a viral infection
• Other Common Causes: widespread hives can be an allergic reaction to a food, drug, infection, insect bite, or other substances.
• Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Localized hives are not caused by drugs, infection or swallowed foods.
• A severe allergic reaction is called anaphylaxis

See More Appropriate Topic

• If doesn’t look like hives, see RASHES WIDESPREAD AND CAUSE UNKNOWN 
• If it’s probably mosquito bites, see INSECT BITES 

Call 911 Now (your child may need an ambulance) (for symptoms of anaphylaxis)

• Difficulty breathing or wheezing
• Hoarseness or cough with rapid onset
• Difficulty swallowing or slurred speech with rapid onset
• Severe allergic reaction in the past to similar substance and hives present < 2 hours

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Hives began after a bee sting, unusual food or medicine and no previous reactions

Call Your Doctor Within 24 Hours (between 9 and 4) If

• You think your child needs to be seen
• Severe hives (eyes swollen shut, very itchy, etc.) not improved after 2nd dose of Benadryl
• Fever, abdominal pain or joint swelling is present

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Hives interfere with school or normal activities after taking Benadryl every 6 hours for more than 24 hours
• Unexplained hives have occurred 3 or more times

Parent Care at Home

• Hives with no complications and you don’t think your child needs to be seen

Home Care Advice for Hives

1. Localized Hives: For localized hives, wash the allergic substance off the skin with soap and water. If itchy, massage the area with a cold washcloth or ice. Localized hives usually disappear in a few hours and don't need Benadryl.
2. Benadryl: Give Benadryl 4 times per day for widespread hives that itch. (See Dosage chart) (Note: if you only have another antihistamine at home, use that)
   • Contraindication: Weight < 20 pounds (Reason: Benadryl is a sedative). Give your doctor a call for advice.
   • Continue the Benadryl 4 times per day until the hives are gone for 12 hours.
3. Cool Bath: Give a cool bath for 10 minutes to relieve itching. (Caution: avoid any chill) Rub very itchy areas with an ice cube for 10 minutes.
4. Remove Allergens: Give a bath or shower if triggered by pollens or animal contact. Change clothes.
5. Avoid Allergens: If you identify a substance that causes hives, help your child avoid that substance in the future.
6. Contagiousness: Hives are not contagious. Your child can return to day care or school if the hives do not interfere with normal activities.
7. Expected Course: Hives normally come and go for 3 or 4 days, then disappear. Most children get hives once.
8. Call Your Doctor If
   • Severe hives persist after 2nd dose of Benadryl
   • Most of the itch is not relieved within 24 hours on continuous Benadryl
   • Hives last > 1 week
   • Your child becomes worse or develops any of the “Call Your Doctor” symptoms

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