Urticaria in Child
Alerts and Notices
Synopsis
Urticaria is defined as acute (new onset or recurring episodes of fewer than 6 weeks' duration) or chronic (recurring episodes lasting longer than 6 weeks). Chronic urticaria is rare in children.
The most common cause of acute urticaria in children is viral infections, particularly upper respiratory infections. Other causes include food and drug hypersensitivity. Acute urticaria may also be seen as part of anaphylaxis.
Chronic urticaria can be spontaneous or inducible and occurs in approximately 0.1%-0.3% of children.
Related topics: contact urticaria, cholinergic urticaria, physical urticaria, cold urticaria, dermographism, urticaria pigmentosa
Codes
ICD10CM:L50.9 – Urticaria, unspecified
SNOMEDCT:
126485001 – Urticaria
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Many serious illnesses present with urticarial lesions and should be considered with every case of urticaria. When in doubt, children should be observed for 2-4 hours to monitor for disease progression.Diseases with urticarial lesions include:
- Serum sickness / serum sickness-like reaction – Associated with fever, lymphadenopathy, arthralgias (look for refusal to use an extremity), dusky skin lesions, and recent drug (ie, beta-lactam) or sera exposure.
- Kawasaki disease – The child appears ill and is febrile.
- Urticarial vasculitis – Individual lesions last longer than 24 hours and are associated with pain, purpura and/or arthralgias or arthritis (look for joint swelling or refusal to use extremities).
- Mastocytosis (urticaria pigmentosa) – Has persistent yellow-brown macules and plaques that urticate with stroking.
- Acute hemorrhagic edema of infancy – Large annular purpuric papules and plaques, fever, and edema in an otherwise well infant between the ages of 4 months and 3 years.
- Viral exanthem – Nonspecific viral exanthems tend to be more macular and papular with a diffuse distribution.
- Cryopyrin-associated periodic syndromes – Muckle-Wells syndrome, familial cold autoinflammatory syndrome (familial cold urticaria), and neonatal-onset multisystem inflammatory disease.
- Alpha-gal syndrome
- Angioedema – Edema of the subcutaneous or submucosal tissues rather than edema of the dermis with urticaria. It is not pruritic and commonly affects the face (eyelids, earlobes, lips); familial angioedema usually does not have individual small hives.
- Erythema multiforme – Fixed for several days, does not respond to antihistamines, and associated with dusky, necrotic centers (rather than the pale edematous center of urticaria).
- Papular urticaria / insect bites – Often excoriated and lasts longer than 24 hours.
- Dermatographism may mimic urticaria and is induced by firmly stroking the skin. It lasts from 0.5-2 hours.
- Contact dermatitis (irritant, allergic) may have an unusual geometric shape correlating to the inciting irritant and often develops blisters.
- Lupus erythematosus – Often with epidermal changes (scaly, atrophic, or ulcerated).
- Herpes zoster – May initially be urticarial, but lesions are painful and evolve into blisters and crusts.
- Erythema annulare centrifugum – Often with epidermal changes (scale), and lesions persist for weeks.
- Cellulitis
- Fixed drug eruption
- Exanthematous drug eruption
- Lyme disease
- Erythema marginatum
- Juvenile idiopathic arthritis
- Bedbug bite
- Loiasis
- Schistosomiasis
- Strongyloidiasis
- Toxocariasis – A common cause of chronic urticaria.
- African trypanosomiasis
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/03/2018
Last Updated:04/06/2021
Last Updated:04/06/2021
Urticaria in Child