ROBERT M. SELIG, M.D., FAAP
JOANN C. COZZA, D.O., FAAP
DANIEL S. SELIG, M.D., FAAP
ANDORRA PEDIATRICS
8945 RIDGE AVENUE
SUITE 3-4-5
PHILADELPHIA, PA 19128
215-483-8558
Hives
(Urticaria)
What are hives?
1. Hives are a very itchy rash caused by an allergic reaction.
2. Hives look like raised pink spots with pale centers on the skin.
3. The spots “blanch.” This means when you press a finger on the spot, the color fades and
then the redness returns when you let go.
4. The spots range from 1/2 inch to several inches wide (hives often look like mosquito bites).
5. The spots may be different shapes. The spots rapidly and repeatedly change in location,
size, and shape in front of you eyes.
What causes hives?
1. Widespread hives are an allergic reaction to a food, medicine, viral infection, insect bite, or
many other possible substances.
2. Often the cause is not found.
3. Hives on just one part of the body (localized) are usually due to skin contact with plants, pollen,
food, or pet saliva.
4. Localized hives are not caused by drugs, infections, or swallowed foods. Hives are not
contagious.
How long do hives last?
1. More than 10% of children get hives.
2. Most children who develop hives have them only once.
3. The hives come and go for 3 or 4 days and then mysteriously disappear.
4. With hives, large swellings are common around the eyes, lips, and genitals.
5. Some young children become sensitized to mosquito or flea bites. They develop big hives
(called papular urticaria) at the sites of old and new bites. These hives may last for
months.
Treatment
Avoidance and showers
Avoid anything you think might have caused the hives. For hives triggered by pollen or animal
contact, take a cool shower or bath. For localized hives, wash the allergic substance of the skin with
soap and water. Localized hives usually disappear in a few hours and don't need Benadryl.
Itching
Use a cool bath to relieve itching. Rub very itchy areas with a cold washcloth or ice cube for 10
minutes.
Antihistamine medicine
The best drug for hives is an antihistamine. An antihistamine won't cure the hives, but it will
reduce their number and relieve itching.
Diphenhydramine (Benadryl)
(dye fen hye' dra meen)
Diphenhydramine one of the most commonly used drugs for hives, is available without a
prescription. The main side effect of this drug can be drowsiness. Generic Claritin, Zyrtec, and
Allegra are less sedating antihistamines and can be used once a day
Diphenhydramine Dosing
Weight
(pounds)
20
Liquid
12.5mg/tsp
¾ tsp
Chewable
12.5 mg
25
1 tsp
1
38
1 ½ tsp
11/2
50
2
2
100
4
4
Give up to 4 times a day
Capsule
25 mg
1
2
Claritin (Loratidine, Alavert)
Adults and children older than six years of age: 10 mg once daily
Children 2-5 years old: 5 mg once daily
Available OTC as:
1. 10 mg tablet, 10 mg RediTab, 10 mg Liquid-Gel
2. Syrup: 5 mg/tsp
3. 5 mg Chewable
Zyrtec (Cetirizine)
Adults and children older than 12 years of age: 10 mg once daily (5 mg for less severe symptoms)
Children 6-11 years old: 5-10 mg once daily (1-2 tsp)
Children 2-5 years old: 2.5 mg once daily (1/2 tsp)
Children 6 months to 23 months: 2.5 mg once daily (1/2 tsp)
 Available OTC as: Syrup: 5 mg/tsp, 10 mg tabs, Liquid gels, Chewable, 5 mg t abs
Allegra (Fexofenadine)
Adults and children 12 years old and over: 60 mg twice a day or 180 mg once a day.
Children 6 to 11 years of age: 30 mg twice a day.
Children two to five years old: 30 mg (one teaspoonful) twice daily.
Children six months up to two years old: 15 mg (1/2 teaspoonful) twice daily.
Common mistakes in the treatment of hives
Many parents wait to give the antihistamine until new hives have appeared. This means your
child will start itchy again. The purpose of the medicine is to keep your child comfortable until the
hives go away. Therefore, give the medicine regularly until you are sure the hives are completely
gone.
Hives are not contagious and your child can be with other children.
When should I call my child's health care provider?
Call IMMEDIATELY if:
• Breathing or swallowing becomes difficult.
• Your child starts acting very sick.
Call during office hours if:
• Most of the itch is not relieved after your child has been taking an antihistamine for 24 hours.
• Most of the itch is not relieved after 24 hours on continuous Benadryl.
• The hives last more than 1 week.
• You have other concerns or questions.
Adapted from handout written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.