Infant Hives (Urticaria): Treatment & When to Worry

Acute urticaria in infants is usually self‑limited (hours to days).

First‑Line Treatment

• Second‑generation H1 antihistamine: Cetirizine (0.25 mg/kg daily) or loratadine – less sedating.
• Dose by weight/age per pediatrician.
• Topical: Calamine lotion, 1% hydrocortisone cream (short‑term, avoid eyes/diaper area).

Second‑Line (if refractory)

• Short course oral prednisolone (1 mg/kg/day × 3–5 days) – specialist guided.
• H2 blocker (famotidine) add‑on – limited evidence.

Common Triggers in Infants

• Foods (cow's milk, egg, peanut, soy, wheat).
• Viral infections (most common overall).
• Drugs (antibiotics, vaccines – rare).
• Contact (detergents, fabrics, pet dander).

Red Flags – Emergency

• Stridor, wheezing, respiratory distress (angioedema/anaphylaxis).
• Swelling of lips, tongue, eyelids.
• Vomiting, diarrhea, lethargy.
• Hives + fever + joint swelling (serum sickness‑like).

Chronic Urticaria (>6 weeks)

Requires allergist/immunologist workup (autoimmune, physical urticarias, infections).