Viral Hives In Children: What Doctors Want You To Know

You put your sleepy, slightly stuffed-up toddler down for a nap, and when you go to pick them up an hour or two later, you notice splotchy, slightly raised, red spots on their skin. Did you know that the stuffy nose — whether it’s from an RSV infection, or some other, common cold virus — could be the culprit? Viral hives in children are incredibly common, and in fact, “viral infections are the most common reason that children experience hives,” Dr. Natasha Burgert, a board-certified pediatrician, tells Romper. But what viruses cause hives, or urticaria (the clinical name for hives), in children? And how can you be sure that the red, slightly itchy rash on your child’s body is viral hives and not something more concerning? While it’s always a good idea to check in with your pediatrician when you notice something new, once you’ve confirmed a diagnosis of viral hives, you should be able to breathe a little easier, as they are generally not difficult to manage at home.

What are viral hives?

Before we get into the specifics of viral hives, perhaps we should define hives themselves, which can be caused by a virus or an allergic reaction. Hives are a “local inflammatory reaction caused by release multiple mediators resulting in red, raised lesions that are very itchy,” says Dr. Mark Toney, Division Chief of Hospital Pediatrics, Nemours Children's Health at Wolfson Children’s Hospital. Viral hives, as the name suggests, are simply hives that are caused by a virus. Viral hives are:

• Red
• Raised
• Often itchy

“Rashes with viral infections are common in children,” explains Dr. Maureen Bauer, a specialist in Pediatric Allergy & Immunology at Children's Hospital Colorado. “So, viral hives are when the rash looks like hives-red, raised and itchy.”

How long do viral hives last in children?

While viral hives are often short-lived, it is not unusual for them to last anywhere from a few days to weeks. “There is a range but typically they last days to a few weeks,” says Bauer. Our experts agree that nailing down the exact timeline can be tricky, as young children can get multiple viruses in succession. “Individual hives can appear and worsen over minutes to hours and then typically disappears in 24 hours. This cycle can occur over 1-3 weeks usually,” Toney explains, adding that “chronic hives is defined as this pattern lasting longer than 6 weeks.”

However, Burgert is quick to add that true chronic hives are very rare, and particularly hard to diagnose: “Idiopathic or recurring hives can be tricky to diagnose since young children commonly get back-to-back viral illness. With each infection, it's possible for a new round of hives to develop. This repeated cycle can make it appear like the hives are chronic, rather than simply a symptom of frequent infections.”

What viral infections cause hives in children?

Viral hives in children are so common that, typically, your pediatrician will not test to find out which virus is causing them. Our experts agree that the list of viruses that can cause hives is long, and includes:

• Picornaviruses
• RSV
• Coronaviruses
• The many viruses that cause the common cold

But, specific viruses aside, exactly what is going on in your child’s immune system that causes them to break out in hives? “The infection-fighting power of a child's immune system causes viral hives,” Burgert explains. “As the immune system ramps up, various body cells are called into action, including those that release histamine. When histamine is released into the bloodstream, hives may develop on the skin.”

How do you treat viral hives in children?

Knowing that viral hives in children — much like their allergy-induced counterparts — are caused by a histamine reaction, you may suspect that an antihistamine is the way to go in terms of treating viral hives at home. Once you’ve confirmed checked in with your pediatrician, our experts agree that home care is sufficient for viral hives in children.

If the viral hives are not bothering your child, you can opt not to treat them at all.

Beyond that, treatment is “something parents should talk to their doctor about,” encourages Bauer. “Typically, we would recommend using a non-sedating antihistamine to help until they go away.  The hives typically resolve when the viral infection is gone.” If your child is itchy or seems to be bothered by the hives, Burget suggests the following:

• Long-acting antihistamines, like Zyrtec or Claritin, for children as young as 6 months
• Topical over-the-counter hydrocortisone to lessen itch
• Topical calamine lotion to lessen itch and discomfort
• Oatmeal baths and ice packs to relieve and soothe itching skin

“Hives that occur during or after viral illnesses are not harmful to children, but can be annoyingly uncomfortable,” explains Burgert. “The good news is that this type of rash can be easily managed.”

Hives in toddlers that go come and go: Why does this happen?

You noticed a little rash on your child’s skin, but it disappeared right when you were about to call the doctor about it, only to — maddeningly — reappear the next morning. It may strike you as strange to see a skin reaction come and go, but in fact, “the ‘come and go’ is classic for hives and actually helps us in separating this from other, more worrisome rashes,” explains Toney. “The local reaction can occur throughout the course of the illness and involve various skin locations at different times. There will also be a response when the antihistamine is working and when it starts to wear off.”

When to worry about hives in children

Hives become a medical emergency if they are associated with any of the following respiratory symptoms, according to Toney:

• Bad cough
• Wheezing
• Any difficulty in breathing

Parents should connect with their pediatrician for advice if they notice the rash:

• Becomes painful to the touch
• Isn’t improving with simple over-the-counter medications
• Looks more like a bruise
• Lasts for more than a few days

Hives due to a food allergy are more concerning, but will typically happen “reproducibly in 1-2 hours after eating the food and are often accompanied by other symptoms,” says Bauer. “If parents notice hives in relation to a particular trigger they should talk to their doctor.”

If your child seems to be feeling alright, breathing normally and your pediatrician has confirmed that their rash appears to be viral hives, you should be fine to manage them at home with TLC and maybe an OTC antihistamine. That said, “I hold a lot of value in parent perception of the acuity of their child,” Toney adds. “The above symptoms are definite, but when a parent’s concern is raised, they should get their child evaluated.”

Experts:

Dr. Natasha Burgert, M.D., a board-certified pediatrician

Dr. Mark Toney, M.D., Division Chief of Hospital Pediatrics, Nemours Children's Health at Wolfson Children’s Hospital

Dr. Maureen Bauer, M.D., a specialist in Pediatric Allergy & Immunology at Children's Hospital Colorado