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Urticaria in Child
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Urticaria in Child

Contributors: Gloria Chen BA, Elyse M. Love MD, Craig N. Burkhart MD, Dean Morrell MD, Jeffrey M. Cohen MD, Susan Burgin MD
Other Resources UpToDate PubMed


Urticaria is a skin disorder characterized by wheals (hives), angioedema, or both. It is 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 categorized as acute (new onset or recurring episodes of up to 6 weeks' duration) or chronic (recurring episodes lasting longer than 6 weeks). Chronic urticaria can be spontaneous or inducible and is estimated to occur in 0.1%-1.8% of children.

The most common cause of acute urticaria in children is viral infection, particularly upper respiratory infections. Other causes include food allergy and drug hypersensitivity. In some cases, the inciting factor is never identified.

Chronic urticaria is less commonly seen in children than in adults. Prognosis is also more favorable in children than in adults, with over 95% resolution after 7 years. Chronic urticaria is subdivided into chronic inducible urticaria and chronic spontaneous urticaria, based on whether definite triggers exist and can be identified. Chronic inducible urticaria is triggered consistently, reproducibly, and exclusively by a specific stimulus. These stimuli further define chronic inducible urticaria subtypes: symptomatic dermographism, cold urticaria, delayed pressure urticaria, solar urticaria, heat urticaria, and vibratory angioedema are physical urticarias, whereas cholinergic urticaria, contact urticaria, aquagenic urticaria, and adrenergic urticaria are not.

Chronic spontaneous urticaria may be exacerbated by triggers such as NSAIDs, alcohol, and stress, but triggers are not definite, as stimuli do not always produce symptoms. While the cause of chronic spontaneous urticaria is unknown, the presence of mast cell–activating autoantibodies in many patients raises the possibility of an autoimmune origin. It is also associated with other autoimmune conditions, including vitiligo and type 1 diabetes mellitus.

Other associated factors:
Related topics: cholinergic urticaria, cold urticaria, contact urticaria, dermographism, physical urticaria, 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.

Differential diagnosis:
Diseases with urticarial lesions:
  • Cryopyrin-associated periodic syndromes – Muckle-Wells syndrome, familial cold autoinflammatory syndrome (familial cold urticaria), and neonatal-onset multisystem inflammatory disease.
  • Phospholipase Cg2–associated antibody deficiency – Lifelong cold-induced urticaria with variable antibody deficiency and increased risk for infection, autoimmunity, and granulomatous disease.

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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:12/13/2022
    Last Updated:12/26/2022
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    Patient Information for Urticaria in Child
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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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