Urticaria in Children (Hives)

Urticaria is a common skin condition and has been characterized as well-circumscribed, intensely pruritic, raised wheals (edema of the superficial skin) typically 1 to 2 cm in diameter, but can be larger when they coalesce; they also can appear pale to brightly erythematous (Schaefer ET ALL 2011).

It can occur in any age range and has a lifetime prevalence of approximately 20% in the general population (Schaefer ET ALL 2011).

Urticaria, with or without angioedema, can be classified as acute or chronic. In acute urticaria, although individual wheals resolve within hours, they can recur for up to six weeks, depending on the etiology and can occur on any part of the skin (Schaefer ET ALL 2011).

Urticaria & CMPA

What causes urticaria in infants?

The most common cause of acute urticaria in infants is food allergens, such as milk/dairy protein allergy. Exposure to insect bites, medication, or infection can also result in urticaria (Schaefer ET ALL 2011). The causes of acute urticaria can often be identified in infants, while in chronic urticaria the specific trigger can only be found in 10–20% of cases (Kulthanan K., 2008).

Could it be a symptom of Cow’s Milk Protein Allergy?

Acute urticaria is one of the many cutaneous symptoms of Cow’s Milk Protein Allergy (CMPA) (Lifschitz C. and Szajewska H 2015). Urticaria has been reported to occur as a symptom of CMPA in almost 30% of infants and usually appears rapidly following the ingestion of cow’s milk/dairy proteins (Hill et al 1988; Vandenplas et al 2007).

However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Høst & Halken 1990; Høst et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022) .