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Acute urticaria
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TriggerChoose one
Anaphylaxis screenChoose any
AngioedemaChoose any
AntihistamineChoose one
TitrationChoose any
Additional medicationChoose any
EpinephrineChoose any
ReferralChoose one
Follow-upChoose one
Counseling
Hives come and go, with each spot usually fading within a day, and can keep appearing for days to a few weeks. Hives in children often follow a viral illness. Testing is not needed unless a trigger is suspected, and there is no need to cut foods from the diet without a clear reaction. Recommended supportive care with an emphasis on avoiding any suspected trigger, cool compresses, and loose clothing; heat, tight clothing, and motrin can make hives worse. Call 911 or go to the emergency department for trouble breathing, throat or tongue swelling, repeated vomiting, or fainting. Return precautions given including hives with fever, joint swelling, or bruise-like spots, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
What the sources cover
- Differentiate from anaphylaxis
- Epinephrine if anaphylaxis not excluded
- Identifiable triggers (viral, food, medication)
- No labs, viral testing, biopsy or empiric elimination diets
- Allergy testing if history suggests
- Antihistamines first line; second-generation preferred
- First-generation sedation counseling
- H2 antagonist add-on
- Brief oral steroid for severe or refractory
- Allergy referral past 6 weeks
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- NSAIDs, heat, tight clothing may worsen
- Anaphylaxis return precautions