Dr Despoina Denaxa-Kyza

Urticaria is a common skin rash that presents in childhood. It is itchy, lumpy and red  often called hives, wheals or nettle rash. Over half of patients with urticaria will also have angioedema. Angioedema is swelling, often of the face or lips or any other area. Less frequently angioedema occurs without urticaria.

When you see your allergist what is important is to separate whether your child has acute or chronic urticaria.

Acute urticaria is a rash that lasts for up to six weeks. It may be due to an allergy if it lasts a day or two. Urticaria caused by allergies can recur on repeated exposure, in which case it is called Acute Intermittent Urticaria. If the rash persists for a few days to a few weeks, the usual trigger in children is a viral infection rather than an allergy.

Chronic urticaria is when although individual spots last less than 24 hours, they occur most days and this lasts more than six weeks. It affects 1 in 200 children.

Chronic urticaria is not associated with severe allergic reactions (anaphylaxis) and adrenaline autoinjector is not required. However, it can impact on quality of life by causing difficulty sleeping and problems concentrating at school.

During our consultation we will discuss whether further tests are required to explore for any triggers.  Most common triggers are sun, cold, heat, stress, exercise, rubbing, viruses and no tests are required. If no cause is found, this is called idiopathic urticaria.

Regarding management that depends if your child suffers from acute or chronic urticaria. In cases of chronic long term antihistamines in doses up to x4 standard dose may be required. In cases of poor response we will discuss the use of biologics (omalizumab) which blocks igE immunoglobulin. The injections are monthly and can be used for up to 6 months for each course.

Prognosis is variable for chronic urticaria. 40% of patients are symptom free after one year and 70% after 4 years.

If your child only presents with symptoms of angioedema they need assessment by an allergist to rule out hereditary causes or other conditions. In some cases drugs like ACE  inhibitors such as enalapril and NSAIDS such as ibuprofen may be the trigger.