From the Guidelines
For pediatric hives (urticaria), the first-line treatment is oral antihistamines, with cetirizine (Zyrtec) at 2.5-5 mg once daily for ages 2-5 years or 5-10 mg daily for older children being a preferred option, as supported by recent guidelines 1. The treatment of pediatric hives should prioritize the use of non-sedating antihistamines, such as cetirizine or loratadine, due to their efficacy and safety profile 1. Some key points to consider when treating pediatric hives include:
- Using antihistamines as the mainstay of therapy, with over 40% of patients showing a good response 1
- Considering the use of sedating antihistamines, such as diphenhydramine, for severe itching at night, but being aware of their potential for drowsiness 1
- Implementing an "as much as needed and as little as possible" approach, stepping up or down treatment based on disease control assessed with the UCT score 1
- Monitoring patients for potential side effects and adjusting treatment accordingly, especially when using higher doses of antihistamines or adding other medications like omalizumab or cyclosporine 1
- Providing additional relief measures, such as cool compresses, lukewarm baths with colloidal oatmeal, and loose, cotton clothing, to help manage symptoms and improve quality of life.
From the Research
Treatment Options for Pediatric Hives
- Antihistamines are commonly used to treat hives in children, as they alleviate symptoms caused by histamine release 2
- Second-generation antihistamines are preferred due to their selective action on peripheral H1 receptors, resulting in fewer adverse effects 2
- For acute urticaria, H1 antihistamines and short-term systemic corticosteroids are the preferred treatment options 3
- In cases of chronic urticaria, antihistamines may be used in higher doses, and cyclosporine can be considered for patients who are resistant to antihistamine treatment 4
Diagnosis and Evaluation
- Diagnosis of urticaria is typically made clinically, with a thorough medical history and physical examination 5
- Laboratory evaluation may be necessary to confirm the etiology of acute urticaria, but universal allergy testing is not recommended for chronic urticaria 5
- Urticarial vasculitis should be considered in cases where lesions are painful, persistent, or accompanied by systemic symptoms 5
Additional Considerations
- Avoidance of triggers is an essential part of treatment, if identified 6
- First-generation H1 antihistamines, H2 antihistamines, leukotriene receptor antagonists, and brief corticosteroid bursts may be used as adjunctive treatment for chronic urticaria 6
- Refractory chronic urticaria may require referral to subspecialists for additional treatments, such as omalizumab or cyclosporine 6