Tag: hives

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

Avoiding Confusion During an Allergy Attack – Adrenaclick vs EpiPen Directions

Learn how to avoid confusion by learning when and how to use different epinephrine injections, including the EpiPen and Adrenaclick injectors.

Whether you have an EpiPen or Adrenacick injector, make sure everyone around your child with allergies knows how to use it.
The FARE Food Allergy & Anaphylaxis Emergency Care Plan provides detailed instructions for all available epinephrine injectors.

The price of EpiPens has been in the news a lot recently.

Most people know that they went Mylan’s EpiPen 2-Pak went from costing about $100 in 2006 to over $600 today and that there has been little or no competition.

One competing device, Auvi-Q was recalled in 2015, but it was fairly expensive too.

Good News and Bad News About EpiPens

Things have gotten better recently.

First, a generic EpiPen 2-Pak is now available. It costs $339.99. While still expensive, it does lower co-pays for many people with good insurance.

The latest news? A generic Adrenaclick injector for $109.99 at CVS pharmacies.

Even better, coupons are available that can make the injectors free for many people.

So what’s the bad news?

The directions for using the EpiPen 2-Pak and the Adrenaclick are not the same. That can cause some confusion. Do you want someone to grab one and not be sure how to use it when your child is having a life-threatening allergic reaction?

That makes it important for everyone to be familiar with both types of epinephrine injectors.

Adrenaclick vs EpiPen 2-Pak Directions

The fact that the Adrenaclick has two caps that you need to remove before use, while the EpiPen only has one, can lead to confusion. Also, the Adrenaclick injector, despite its name, doesn’t actually ‘click’ after you use it, like the EpiPen does.

EpiPen 2-Pak auto-injector directions:

  1. Remove the EpiPen Auto-Injector from the clear carrier tube to find an EpiPen Jr (green label) or EpiPen (yellow label).
  2. Remove the blue safety release by pulling straight up without bending or twisting it.
  3. Swing and firmly push orange tip against mid-outer thigh until it ‘clicks’.
  4. Hold firmly in place for 3 seconds (count slowly 1, 2, 3).
  5. Remove auto-injector from the thigh and massage the injection area for 10 seconds.

Remember that the orange end is the needle end! And you know that your child got your dose if you heard the click sound.

Adrenaclick epinephrine auto-injector directions:

  1. Remove the outer case.
  2. Remove grey caps labeled “1” and “2”.
  3. Place red rounded tip against mid-outer thigh.
  4. Press down hard until needle enters thigh.
  5. Hold in place for 10 seconds. Remove from thigh.

With the Adrenaclick injector, the red tip end is the needle end! Do not touch this end or you could unintentionally inject your self. After use, the needle should be visible.

Avoiding Confusion About Your Epinephrine Injector

All of the epinephrine injectors are easy to use. At least on paper.

In the heat of the moment though, when a child is having a life-threatening allergic reaction, it may not seem so easy though.

It will likely be even more difficult if the epinephrine injector you grab is not what you are expecting. Make sure you know how to use your epinephrine injector, both when your pediatrician prescribes it and when your pharmacist dispenses it to you (in case you get a different one, which is allowed in some states).

  1. Read the instructions.
  2. Watch a video.
  3. Use a trainer device.
  4. Be prepared!

It is also important that anyone that watches your child, whether it is a family member or the school nurse, knows how to use your child’s epinephrine injector.

“Individuals and caregivers are often reluctant to use self-injectable epinephrine in anaphylaxis despite instruction to do so.”

Pediatrics March 2007

Other things that can lead to confusion about epinephrine injectors include that you:

  • use an EpiPen or Adrenaclick training pen instead of the real injector with active medication when your child is having an anaphalytic reaction
  • use the real injector when you meant to use the training pen
  • don’t carry your child’s epinephrine injector with you at all times, which is why it is important to get more than one injector each time, allowing you to keep one at school, one at home, and one and travels with your child, etc., eventually allowing your child to carry his or own epinephrine injector at an age-appropriate time
  • forget to move to a higher dose of epinephrine as you child grows, keeping in mind that the Jr (0.15mg) dosing is only for kids under 66 pounds
  • aren’t sure when to use your EpiPen or Adrenaclick injector or are afraid to use it, which can lead to an unnecessary delay in your child getting a lifesaving treatment
  • don’t get a refill if your epinephrine injectors have expired or you actually needed to use one
  • understand that you still need to call 911 after you have used your epinephrine injector, even if your child begins to immediately feel better. Symptoms can return, which is why you are given two doses (2-Pack) of epinephrine.

A good Food Allergy & Anaphylaxis Emergency Care Plan can help avoid much of this confusion. In addition to easy to read instructions on when to give epinephrine, this type of plan should include directions for your child’s epinephrine injector.

When in doubt – you should usually give epinephrine if you have any concerns that your child is having an anaphylactic reaction. It is a safe medicine.

More Information About Epinephrine Injectors

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How To Avoid Peanut Allergies

To prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually feed their infants peanut-containing foods!

Infants with eczema are at high risk for developing peanut allergies.
Infants with eczema are at high risk for developing peanut allergies. Photo courtesy of the NIAID.

The worst part of having a severe allergy to peanuts isn’t the high price of EpiPens.

It is that peanut allergies can be deadly, even when you have access to an EpiPen.

And since there is no 100% fool proof way to avoid peanuts and peanut containing foods, doctors have been trying to come up with ways to prevent kids from ever developing peanut allergies.

The first efforts, to avoid peanuts and other high risk foods during pregnancy and early infancy, likely backfired, leading to even more kids with peanut allergies. That’s why recommendations for starting solid foods changed back in 2008, when the American Academy of Pediatrics began to tell parents to no longer delay giving solid foods after age 4 to 6 months and that it wasn’t necessary to delay “the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.”

The latest guidelines are the next evolution of that older advice.

Now, in addition to simply not delaying introducing allergy type foods, as part of a new strategy to prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually give their infants peanut-containing foods!

Prevention of Peanut Allergies

Developed by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with 25 professional organizations, federal agencies, and patient advocacy groups, these clinical practice guidelines recommend that parents:

  1. introduce peanut-containing foods into your infant’s diet as early as 4 to 6 months of age if they have severe eczema, egg allergy, or both (strongly consider allergy testing first)
  2. introduce peanut-containing foods into your infant’s diet around 6 months of age if they have mild to moderate eczema
  3. introduce peanut-containing foods into your infant’s diet in an age-appropriate manner with other solid foods if your infant has no eczema or any food allergy

Keep in mind that it is possible that your baby already has a peanut allergy, so discuss your plan to introduce peanut-containing foods with your pediatrician first. But don’t be in such a rush that you make peanut-containing foods your baby’s first food. Offer a cereal, veggie, fruit, or meat first. If tolerated, and you know that your baby is ready for solid food, and with your pediatricians okay, then consider moving to peanut-containing foods.

And although not always necessary, it is possible to do allergy testing even on younger infants. Testing is an especially good idea if your infant has severe eczema or an egg allergy. For these higher risk kids, referral to an allergy specialist might even be a good idea, where infants can start peanut containing foods in their office (supervised feeding) or as part of a graded oral challenge. Your pediatrician might also consider supervised feeding for your higher risk child who is not allergic to peanuts.

Peanut-Containing Baby Food Recipes

So how do you give a 4 or 6 month old peanut-containing foods?

It’s not like Gerber has any 1st or 2nd foods with peanuts – at least not yet…

So for now, you can:

  • add 2 to 3 tablespoons of hot water to 2 teaspoons of thinned, smooth peanut butter. Stir until the peanut butter dissolves and is well blended. You can feed it to your baby after it has cooled.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of thinned, smooth peanut butter.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of peanut flour or peanut butter powder.

Each of these recipes will provide your baby with about 2g of peanut protein. Since the goal is to give your child about 6 to 7g a week, you should offer them three separate times.

During the first feeding, it is important to only “offer your infant a small part of the peanut serving on the tip of the spoon,” and then wait for at least 10 minutes to make sure there are no signs of an allergic reaction, such as hives, face swelling, trouble breathing, or vomiting, etc.

Of course, because of the risk of choking, you should not give infants or toddlers whole peanuts or chunks of peanut butter.

More Information on Preventing Peanut Allergies

Ten Things That Aren’t As Scary As Most Parents Think

Parenting can be a little less scary if you are prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.

Being a parent can be scary enough.

Don’t let these every day parenting issues freak you out even more.

Be prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.

  1. Breath holding spells – in a typical breath holding spell, a young child cries, either from a tantrum or a fall, etc., and then holds his breath (involuntarily) and briefly passes out. Although it sounds scary and the episode might look like a seizure, these kids usually quickly wake up and are fine after. Kids who have breath holding spells are often prone to repeated spells though, so you do want to warm other caregivers so they don’t freak out if your child has one. Eventually, kids outgrow having them.
  2. Febrile Seizures – parents often describe their child’s first febrile seizure as ‘the worst moment of their life.’ Febrile seizures typically occur when a fever rises rapidly, but although they are scary, they are usually brief, stop without treatment, don’t cause any problems, and most kids outgrow having them by the time they are about five years old.
  3. Nosebleeds – a nosebleed that doesn’t stop is certainly scary, but with proper treatment, most nosebleeds will stop in ten to twenty minutes (if not sooner), even if your child wakes up in the middle of the night with a bloody nose for what you think is no reason.
  4. Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. The scary thing though, is that their child will be confused, likely won’t recognize you, and might act terrified – and it all might last for as long as 45 minutes or more. Fortunately, night terrors are normal. Your child likely won’t even remember what happened the next morning. And they eventually stop.
  5. Eating a Bug – “Kids eat bugs all the time. Few if any symptoms are likely to occur.” – that’s a quote from the National Capital Poison Center, who must get more than a few calls from worried parents about their kids eating bugs. Or finding the evidence later – when you see a dead bug in their diaper…
  6. High Fever – pediatricians have done a lot of education about fever phobia over the years, but parents often still get scared that a high fever is going to cause brain damage or hurt their child in some other way. Try to remember that fever is just another symptom and doesn’t tell you how sick your child is.
  7. Playing Doctor – even though it’s natural for young kids to be curious about their bodies, the average parent is likely going to be scared and upset if they “catch” their kids playing doctor. Understand that it is usually a normal part of child development and don’t turn it into a problem by making it into more than it is.
  8. Hives – a child with classic hives might have a red raised rash develop suddenly all over his body. And since hives are very itchy, that child is probably going to be miserable, which can make hives very scary, even though without other symptoms (like vomiting or trouble breathing), they typically aren’t a sign of a serious allergic reaction. The other thing about hives that can be scary is that even when they go away with a dose of Benadryl, they often come back – sometimes for days, but often for weeks. And your pediatrician might not be able to tell you what triggered them.
  9. Croup – your child goes to bed fine, but then wakes up in the middle of the night with a strange cough that sounds like a barking seal, has a hoarse cry, and it seems like he is wheezing. Scary, right? Sure, but if you realize he probably has croup and that some time in the bathroom with a hot shower (getting the room steamy can often calm his breathing), you’ll be ready for this common viral infection.
  10. Choking – while choking can be a life-threatening emergency, most episodes of choking aren’t. In addition to learning CPR and how to prevent choking, remember that if you child “is still able to speak or has a strong cough” then you may not have to do anything, except maybe 911 if he or she is having some breathing difficulties. It is when your child is choking and can not breath at all (and can’t talk and isn’t coughing) that you need to quickly react and do the Heimlich Maneuver while someone calls 911.

Even with a little foreknowledge and preparation, many of these very common pediatric issues are scary. Don’t hesitate or be afraid to call your pediatrician for more help.

For More Information on Things That Scare Parents

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