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Urticaria in Child
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Urticaria in Child

Contributors: Elyse M. Love MD, Craig N. Burkhart MD, Dean Morrell MD, Susan Burgin MD
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Urticaria, commonly known as welts or hives, refers to raised, erythematous wheals caused by the release of histamine and other vasoactive substances from mast cells. When swelling is superficial, urticaria presents. When the swelling is deeper, angioedema presents.

Urticaria is defined as acute (new onset or recurring episodes of fewer than 6 weeks' duration) or chronic (recurring episodes lasting longer than 6 weeks). Chronic urticaria is rare in children.

The most common cause of acute urticaria in children is viral infections, particularly upper respiratory infections. Other causes include food and drug hypersensitivity. Acute urticaria may also be seen as part of anaphylaxis.

Chronic urticaria can be spontaneous or inducible and occurs in approximately 0.1%-0.3% of children.

Related topics: contact urticaria, cholinergic urticaria, physical urticaria, cold urticaria, dermographism, urticaria pigmentosa


L50.9 – Urticaria, unspecified

126485001 – Urticaria

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Differential Diagnosis & Pitfalls

Many serious illnesses present with urticarial lesions and should be considered with every case of urticaria. When in doubt, children should be observed for 2-4 hours to monitor for disease progression.

Diseases with urticarial lesions include:
  • Serum sickness / serum sickness-like reaction – Associated with fever, lymphadenopathy, arthralgias (look for refusal to use an extremity), dusky skin lesions, and recent drug (ie, beta-lactam) or sera exposure.
  • Kawasaki disease – The child appears ill and is febrile.
  • Urticarial vasculitis – Individual lesions last longer than 24 hours and are associated with pain, purpura and/or arthralgias or arthritis (look for joint swelling or refusal to use extremities).
  • Mastocytosis (urticaria pigmentosa) – Has persistent yellow-brown macules and plaques that urticate with stroking.
  • Acute hemorrhagic edema of infancy – Large annular purpuric papules and plaques, fever, and edema in an otherwise well infant between the ages of 4 months and 3 years.
  • Viral exanthem – Nonspecific viral exanthems tend to be more macular and papular with a diffuse distribution.
  • Cryopyrin-associated periodic syndromes – Muckle-Wells syndrome, familial cold autoinflammatory syndrome (familial cold urticaria), and neonatal-onset multisystem inflammatory disease.
  • Alpha-gal syndrome
Other diseases with urticaria-like lesions include:

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:04/03/2018
Last Updated:04/06/2021
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Urticaria in Child
A medical illustration showing key findings of Urticaria : Erythema, Recurring episodes or relapses, Scattered many, Serpiginous configuration, Pruritus, Hives
Clinical image of Urticaria - imageId=376064. Click to open in gallery.  caption: 'Edematous pink papules and plaques on the arm.'
Edematous pink papules and plaques on the arm.
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