The most common concerns of allergy patients?
Nov 23, 2018
It is estimated that 10-20% of the population experiences an episode of acute urticaria (hives) at least once in their lifetime, with or without angioedema. Urticaria and angioedema are the same condition and can occur separately or together. Recognizing urticaria is usually not a problem, but other aspects of the condition often remain unclear. The onset of the condition can occur at any age, and it is relatively common in children.
Causes of urticaria
There are many causes of urticaria in children, and the role of various foods, especially cow's milk, as a cause of allergies in this age group is often overestimated.
The appearance and size of hives have no prognostic or diagnostic significance. It’s important to know that hives usually resolve on their own in a few days without leaving any marks or scars. The intensity of urticaria can vary throughout the day depending on several factors: outside temperature, the child's emotional state, type of clothing, hormonal status, etc. So-called giant hives are not more severe than other forms; they simply involve a greater degree of blood vessel dilation.
Testing and treatment
Allergy tests are never performed during the acute phase of the condition, and they are usually not recommended if the symptoms are occurring for the first time.
The approach to treating a child with allergies should be swift and clear. Parents should be patiently educated about the nature of the condition and its course. Aggressive treatments (such as parenteral antihistamines and corticosteroids) can create confusion for both patients and their parents. While these medications may temporarily relieve symptoms, the condition remains in the body and reappears once the medication’s effects wear off, which can lead to anxiety in parents and increase their concerns about the severity of the illness.
It’s important to note that urticaria rarely represents a symptom of serious systemic diseases in children. Also, difficulty breathing due to laryngeal edema is rare, and when it does occur, it usually appears simultaneously with the skin changes, meaning the risk of a child with hives developing this condition is low.
A common misconception: food allergies and strict diets
Almost every case of urticaria is associated with a food allergy, and many people automatically assume that a strict diet is necessary. However, we now know that true IgE-mediated allergies are rare (around 5% of all allergies), so strict diets, especially for children, are rarely implemented. The use of elimination diets, especially for children with acute urticaria, is problematic. The vast majority of these cases resolve without the need for food elimination. If there is a justified suspicion of a food allergy, a short-term elimination of the most common allergens like peanuts, eggs, nuts, and fish is recommended.
Urticaria treatment
Antihistamines are the primary treatment for urticaria, and non-sedating antihistamines are typically used orally for about 7 days. The presence of angioedema during an episode of urticaria does not alter the treatment approach, as angioedema is identical to urticaria. The exception is dramatic laryngeal edema, which, as noted, is rarely seen in children.
The medications should be administered orally in the form of syrup or tablets. Parenteral administration (injections or intravenously) is not recommended, and local use is prohibited. In cases of severe changes (giant hives), taking a cool shower can help cause blood vessel spasms, which reduce the size of the hives and alleviate itching.