Tag: allergens

What is Triggering Your Child’s Hives?

Learn how to treat your child’s hives, which could have been triggered by a food, drug, or recent viral infection.

Has your child ever had hives?

What was the first thing you thought of?

If you’re like most parents, it is likely what your child had recently eaten, thinking that is most likely to be what is causing their allergic reaction.

Hives can be scary, because they can appear suddenly all over your child's body. They are one of those things that typically looks worse than it is though.
Hives can be scary, because they can appear suddenly all over your child’s body. They are one of those things that typically looks worse than it is though. Photo by Sussman et al (CC BY 4.0)

It is important to remember that there are many more things in addition to food allergies that can cause hives in kids though. These include medications, infections, exposure to the sun, and for some kids, even physically stroking their skin, which is called dermographism.

What are Hives?

A hive on your child's lip is much different from swelling inside their mouth and throat.
A hive on your child’s lip is much different from swelling inside their mouth and throat. Photo by Sussman et al (CC BY 4.0)

Hives are a type of allergic or immune system reaction that occurs when something triggers the release of chemicals, including histamine, from cells in a child’s body.

Hives are usually harmless if they are the only symptom your child is having.

Unfortunately, children with hives and more severe symptoms, such as wheezing, difficulty breathing or swallowing, or swelling in their mouth or throat, may have anaphylaxis – a life-threatening allergic reaction. These children need immediate medical attention.

Symptoms of Hives

In addition to their typical appearance as red or pink raised areas on your child’s skin, hives are usually:

  • itchy
  • seen alone or are in groups
  • varied in size, with some being smaller than your child’s finger tip and other’s larger than a half-dollar size. Also, hives can often merge or join to form even larger hives that, for example, can cover half of your child’s abdomen.
  • temporary and come and go over several hours. They often don’t go away completely though. Instead, old hives go away in one part of your child’s body, while new ones continue to appear somewhere else. Any individual hive shouldn’t last more than 24 hours. If it does, then your child may have a similar skin rash, such as erythema multiforme, and not simple hives.

Less commonly, hives can sting, be painful, and can leave bruises on your child’s skin.

Kids with hives may have additional symptoms depending on what is triggering the hives. For example, if a viral infection is causing the hives, then they may have a sore throat, runny nose, and/or cough.

What is Triggering Your Child’s Hives?

Although some things, such as certain foods, commonly cause hives, keep in mind that almost anything can trigger hives.

Common causes of hives can include:

  • foods, especially peanuts, eggs, tree nuts, milk, shellfish, wheat, and soy
  • medications, especially antibiotics like penicillin and sulfa drugs
  • additives in foods or medications, such as the food dye tartrazine (Yellow No. 5)
  • infections, especially viral infections
  • insect bites and stings
  • latex
  • exercise
  • stress
  • exposure to heat, cold, or water, no matter what the temperature is
  • dermatographism, a physical urticaria, in which hives are triggered by stroking the skin, such as by scratching

How do you figure out what is causing your child’s hives?

It can be hard.

To help figure it out, keep a diary of all of your child’s medications and everything he recently eat or drank, shortly before breaking out.

Allergy testing is sometimes necessary to figure out what is causing hives, especially if your child’s hives are not going away or they keep getting hives over and over. Fortunately, most kids don’t need testing for their hives, and unless the trigger is obvious, like when it follows eating a peanut butter and jelly sandwich or they are on Amoxil for an ear infection, there is a good chance that they won’t get hives again.

Treatments for Hives

Since hives are caused by the chemical histamine, it makes sense that you would treat them with an antihistamine medication, such as diphenhydramine (Benadryl). Other sedating antihistamines that are sometimes used to treat hives include hydroxyzine (Atarax) and cyproheptadine (Periactin).

Non-sedating antihistamines, including Allegra, Claritin, Clarinex, and Zyrtec, are also used to treat hives, expecially hives that last longer than 6 weeks.

Less commonly, a child may need a steroid to treat his episode of hives.

Other treatments, especially for chronic hives, can sometimes include doxepin (Sinequan), an antidepressant that can work as a potent antihistamine, montelukast (Singulair), and medications such as ranitidine (Zantac) or cimetidine (Tagamet), which are more commonly used to treat reflux.

In some cases of persistent hives, your pediatrician might recommend that you give your child multiple medications, for example, both Zyrtec and Allegra, with Zantac!

Of course, the best treatment for hives, whenever possible, is to remove and then avoid whatever has triggering them.

What You Need To Know About Hives

Hives are not considered chronic or long-term until they last for six weeks or longer. Chronic hives are rarely caused by food allergies. In fact, triggers for chronic allergies are only found about 20 percent of the time.

What if no cause is found for your child’s chronic hives? Then your child has idiopathic hives, which should eventually go away.

What else should you know about your child’s hives?

Individual hives are also called welts (not whelps, a common misspelling for welts) or wheals.

It is a common myth that it has to be something ‘new’ that is causing your child’s hives, as it is much more common that your child has had something two, three or more times before it finally triggers hives.

And although an allergic reaction to a food is usually fairly quick, occurring within minutes to hours, it may take days or weeks for an antibiotic to trigger hives in your child. Your child might not even break out until a few weeks after finishing their last dose!

Also keep in mind that a pediatric allergist and/or pediatric dermatologist can often help your pediatrician figure out what is causing your child’s hives.

More on Your Child’s Hives

Is There a Cure for Peanut Allergies?

Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.

Many parents likely got excited recently when they read about a possible cure for peanut allergies.

Peanut allergy could be cured with probiotics
Medical News Today

While these types of treatments are called cures by some people, what they do is desensitize you to peanuts, so that if you have a reaction, it is less severe. Some don’t have reactions anymore though. Probiotics were just part of the ‘cure’ though. They were paired with oral immunotherapy.

Is There a Cure for Peanut Allergies?

So is there really is a cure for peanut allergies?

I’m guessing it doesn’t matter if you call it a cure or a treatment if you have a child with a severe peanut allergy, you really just want to know if it is available for your child, right?

And again, there isn’t a simple answer.

Although it does seem like they are being used more and more, many of these treatments are still being tested, so they likely aren’t available everywhere, or in some cases, anywhere outside of a trial.

Among the treatments for peanut allergies, besides avoidance and treating anaphylactic reactions with epinephrine, you some day soon might be able to get your child with peanut allergies:

  • a wearable skin patch to provide epicutaneous immunotherapy (EPIT)  – in phase III studies
  • a pill to provide orally administered biologic immunotherapy  – in phase III studies
  • oral immunotherapy with Xolair (FASTX) – in phase II studies
  • a combination of probiotics with peanut oral immunotherapy (PPOIT)
  • sublingual immunotherapy (SLIT) – in phase III studies
  • a vaccine – in early phase I studies

How do these treatments work?

The patch is the easiest to explain. Kids simply apply a new patch that contains peanut protein on their skin each day.

Oral immunotherapy is similar, kids are exposed to peanut protein, but unlike the patch, the dose is steadily increased each day, until you read a maintenance dose, that you continue eating each day. Most of these treatments use some variation of the characterized oral desensitization immunotherapy (CODIT) method to control and maintain desensitization.

And these treatments are not just for peanuts. Similar studies are being done for eggs and milk. And theoretically, they can be done for anything that can trigger an IgE-mediated allergic reaction, from foods and medicines to environmental allergens.

The downside? In addition to side effects, in most cases, you have to continue eating the thing you are allergic to every day, otherwise your allergy might return.

So, Is There a Cure for Peanut Allergies?

While many of these treatments are promising, they are not ready for regular use in every doctor’s office.

“The aim of OIT is to administer a food allergen slowly, in small but steadily increasing doses, until the patient stops reacting to the food (termed becoming desensitized to the food). OIT studies have shown promising results, though adverse reactions are frequent and may cause significant side effects like abdominal pain, wheezing and/or diarrhea. Published data from placebo-controlled trials have shown that only 50 to 70 percent of patients attempting OIT complete desensitization, with the failures primarily due to side effects. Also, there currently are no standardized protocols or foods used in OIT and no FDA approved approach that could allow insurance to reimburse for this therapy. Thus, there are challenges with the current practice of OIT.”

FARE Statement on Oral Immunotherapy for Food Allergies

That doesn’t mean that you can’t get some of these treatments right now or overcome those challenges.

Avoiding peanuts is not always as easy as you think... Peanuts under my seat on a plane.
Avoiding peanuts is not always as easy as you think… Peanuts under my seat on a plane. Photo by Vincent Iannelli, MD

Just keep in mind that “An allergist doing OIT for patients in a private practice develops his/her own individualized protocols and uses his/her unique food preparation.”

If your child’s food allergy has led to severe stress and anxiety for your family, that might not matter though. You probably don’t want to wait anymore if there is a chance at reducing your child’s chance of having a severe, life-threatening allergic reaction.

Still, find a pediatric allergist who has a lot of experience doing private practice OIT.

On the other hand, if you are fine refilling your child’s epi-pens every year and working hard to avoid peanuts, then maybe wait until the jury comes in and we get an official recommendation and more standardized treatments become more widely available.

What Else Should You Be Doing About Food Allergies?

If you don’t do private practice OIT, then in addition to strictly avoiding the things to which your child is allergic and making sure that an epi-pen is always readily available, the latest guidelines recommend that your child have:

  • annual testing if they have a milk, egg, soy, or wheat allergy
  • testing every two to three years if they have a peanut, tree nut, fish, or shellfish allergy

Why retest?

Kids do sometimes outgrow their allergies, especially if the allergy isn’t to peanuts or tree nuts. And even for peanuts, about 20% of kids have a chance of outgrowing their allergy.

Also remember that it is now recommended that infants at high risk for peanut allergies, especially those with eczema, have an early introduction of peanut proteins, sometimes as early as four months of age.

Hopefully that will help decrease the number of kids who need these kinds of treatments in the future.

What to Know About Treating Peanut Allergies

Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.

More About Treating Peanut Allergies

Get Control of Your Child’s Allergy Triggers

Identifying your child’s allergy trigger or allergy season won’t make them away. It can help you learn to avoid or control them though, or at least help get prepared by starting your child’s allergy medicines before he is exposed.

What’s triggering your child’s allergies and asthma?

Is it the cat?

The roses she loves to smell?

The dust on all of the stuffed animals in her room?

The Cottonwood tree blooming in the yard next door?

How do you know?

Identifying Allergy Triggers

Roses are not a common allergy trigger.
Roses are not a common allergy trigger.

If your other kids are dog lovers, they are probably voting for the cat, but depending on the time of year, her pattern of symptoms, and where you live, there could be plenty of candidates.

One thing you can check off your list – the roses.

Allergies are typically caused by pollen from trees, grasses, and weeds – not other types of flowering plants, like roses, geraniums, or begonias, etc. These “allergy-friendly” plants don’t produce much pollen. Other plants with flowers that are said to be fairly non-allergenic include orchids, pansies, petunias, snapdragons, and zinnias, etc.

“Brightly colored flowers that attract bees and other insects or humming birds are generally not allergenic.”

Michael J. Schumacher, MB, FRACP, The University of Arizona

In general, plants with wind-borne pollen can trigger allergies.

Are your child’s allergies better after it rains? Since heavy rains can lower pollen counts in the air, that could be a hint to a seasonal allergy trigger.

What about when it is dry and windy? Does that make your child’s allergies worse? Since pollen is carried by the wind, a dry, windy day will likely mean that there is more pollen in the air, which is another hint to a seasonal allergy trigger.

Do your child’s year round allergies quickly get better when he is away from home for a few days or weeks? That could be a hint to something inside your house being a trigger, although if he traveled far away, to another area of the country, it could simply mean that he wasn’t exposed to the same pollen in the air.

Understanding Allergy Triggers

Year round, or perennial allergy symptoms, are likely caused by things inside your home.

If your child’s allergies only seem to be bad at very specific times of the year, then pollen from grasses, trees, or weeds could be the trigger. Which pollen is high in your area when your child’s allergy symptoms are acting up?

Allergy testing is always an option if your child’s allergies are hard to control, either skin testing or a blood test.

Indoor Allergens That Trigger Allergy Symptoms

Year round allergy symptoms can often be caused by things in your home:

  • Cat and dog dander
  • Dermatophagoides farinae and pteronyssinus (dust mites)
  • Mice (mouse allergens/mouse urine proteins)
  • Cockroach saliva, feces, and body parts (cockroach allergens)

While allergy testing can help you figure out which to blame, if you don’t have any indoor pets and can eliminate mold in the house, then maybe you can blame dust mites.

Weeds That Trigger Allergy Symptoms

Most people think of ragweed as the classic weed that can trigger seasonal allergies. Often described as being “packed with pollen,” each ragweed plant produces up to one billion pollen grains each season! These ragweed pollen grains are carried by the wind and can trigger allergy symptoms from early to mid-August through September and October – fall allergy season.

Others weeds that commonly trigger allergies include:

  • nettle
  • mugwort
  • Russian thistle (tumbleweed)
  • plantain
  • Rough marsh elder
  • Rough pigweed
  • Sheep sorrel

Again, if necessary, allergy testing can help you figure out to which weed your child is allergic, but if their allergies peak in the fall, it is likely triggered by weeds.

Trees That Trigger Allergy Symptoms

Which trees are most likely to trigger allergy symptoms?

It depends on where you live, but in the spring, mountain cedar, pecan, elm, maple, birch, ash, oak, and cottonwood, are common offenders.

If you are allergic to tree pollen, you can expect symptoms in late winter to early spring.

Grasses That Trigger Allergy Symptoms

While many people don’t think of summer as a typical allergy season, that is actually when grass pollen is in the air.

Do you know which grasses are commonly grown in your area?

Bermuda grass, Timothy, Kentucky Blue, Johnson, Rye, or Fescue? Are your kids allergic to any of them? If so, their allergy symptoms will probably act up in the late spring and early summer.

Molds That Trigger Allergy Symptoms

Depending on where you live, molds can either cause seasonal symptoms (colder climates) or they can be a cause of year round symptoms.

And you can expect outdoor mold spore counts to be extra high when it is warm and humid.

Inside, mold grows best in parts of the house that are cool and damp, with common suspects including:

  • Cladosporium herbarum
  • Penicillium notatum
  • Alternaria alternata
  • Aspergillus fumigatus

Have you seen any of these names on your child’s allergy test results? Although it is considered part of our natural environment, you can keep mold from growing inside your home.

What To Know About Allergy Triggers

Identifying your child’s allergy trigger or allergy season won’t make them  away. It can help you learn to avoid or control them though, or at least help get prepared by starting your child’s allergy medicines before he is exposed.

More Information about Allergy Triggers

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