Hives are a common skin reaction in children, characterised by a raised, flat pink rash called wheals and are most often caused by allergies.

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Certain foods can trigger them, as can insect bites or some medication. In winter some children can even develop hives when they are exposed to cold air.

Dr Tamatha Urquhart, a paediatrician, from Faerie Glen in Pretoria who specialises in allergies, tells all about hives, what causes them and how to treat them.

“Hives can appear anywhere on the body, including the face, lips, tongue, throat or ears,” she says.

“They may change shape, move around, disappear and reappear over short periods of time.”

The medical term for hives is urticaria. When a person is exposed to something that can trigger hives, certain cells in the body release a substance called histamine. This causes fluid to leak from the small blood vessels under the skin. When this fluid collects under the skin, it forms the blotches, which we call hives.

“They vary in size from a few millimetres to several centimetres and may join together to form larger areas. They can last for hours, or up to one day before fading,” explains Dr Urquhart.

The most common causes are certain foods, medications, or infections. “The most common foods that cause hives are nuts, fish, tomatoes, eggs and dairy.  Certain food additives and preservatives also play a big role,” Dr Urquhart says and adds that it is sometimes difficult to find out exactly why hives have formed.

Physical urticaria is where hives are caused by direct physical stimulation of the skin — for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere.

“It is difficult to determine the exact prevalence of childhood urticaria due to lack of population-based studies.  In my practice, I find acute urticaria to be more common in children than chronic or physical urticaria,” she says.

Hives usually cause itching, but may also burn or sting. While some cases can be mild, urticaria can also be severely debilitating.

According to Dr Urquhart, infection, especially a viral infection, is the most frequently documented cause of acute urticaria in children, responsible for up to 40 percent of cases.

If a child’s hives last for more than a month, Dr Urquhart suggests that you make an appointment to see an allergist, who will take a history and perform a thorough physical exam to determine the cause of your child’s symptoms.

Therapies range from prescription antihistamines and other drugs, such as anti-inflammatory medications and medications that may modify your immune system.

“In some cases, the trigger is obvious – a person eats peanuts or shrimp, and then breaks out within a short time,” she says. Other cases require detective work by the patient, parent and the physician because there are many possible causes. In a few cases, the cause cannot be identified,” she says.

Dr Urquhart says that a single episode of hives does not usually call for extensive testing. If a food allergy is suspected, consider keeping track of what your child eats. This will help you discover whether there is a link between what they are eating and when they break out with hives.

If the cause of hives can be identified, the best treatment is to avoid the trigger or eliminate it.

In mild cases of hives, your doctor may determine that no treatment is required. However, to make a child less itchy and more comfortable, the doctor might suggest an oral antihistamine. Less often, hives can be a sign of a more serious allergic reaction that can affect breathing and other body functions. In these cases, the person needs immediate medical care.

Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives.

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