As a pediatrician, every spring and summer, we often encounter children with sudden rashes in our outpatient and emergency departments. Parents often ask questions like this in pediatrics: "Doctor, do we have a rash? Is it a rash? Is it an allergy?" In pediatrics, rash is not just a disease, but a type of symptom. As long as it occurs on the skin, The pimples can be called "rashes".
and urticaria ( wheal-like itchy rash ) is the most common rash that causes itchy skin. Some parents are familiar with this disease, while others still can't distinguish it clearly. Urticaria often manifests as raised erythema, with the central area often white and wheal-like changes. The erythema has different shapes and sizes. You can refer to the picture below (children with fever and rash admitted to our hospital, this patient Consider urticaria in children, which is an annular erythema-like rash).
So what is urticaria?
Urticaria is a local edema reaction caused by the dilation and increased permeability of small blood vessels in human skin and body mucous membranes. The clinical manifestations are wheals of varying sizes accompanied by itchy rash, sometimes accompanied by angioedema, as shown in the picture below (edema of the skin and mucous membranes around the eyes and lips. The picture shows eyelid edema in a child with urticaria admitted to our hospital. ).
How do children get urticaria?
The causes of acute urticaria are mostly temporary skin irritation and sensitization, including physical stimulation, such as skin friction, pressure, cold, heat, sunlight, etc., and food intake, such as animal protein fish, shrimp, Crabs, shellfish, eggs, etc., plants or fruits such as lemons, mangos, plums, apricots, strawberries, walnuts, cocoa, garlic, tomatoes, etc., and even rotten food in summer can also cause it; drugs are also a common cause, such as Injectable or oral penicillin, various vaccines, codeine ingredients in cough medicines, aspirin, etc.; some common causes are infections, such as bacteria and viruses that children are susceptible to; some older children who are obviously tired or stressed may also Can cause urticaria.
Children have recurrent urticaria, especially acute urticaria, which causes extreme itching and discomfort in children. How to treat it?
Cause treatment:
First, we focus on the causes of allergic rashes in the body. It is necessary to eliminate the inducements or suspected causes, so that the urticaria can subside in time. Most urticaria is mild and self-limiting, that is to say, it does not occur without regular treatment. With active treatment, the rash and itching can improve on its own. For example, if you find that your child has obvious skin rashes and itching after eating fish and shrimp, you can eliminate the intake of such foods. For example, if you find that your child develops urticaria after touching the mat, you will not touch it.
Targeted drug treatment:
The purpose of urticaria treatment is to control the symptoms of itching and discomfort and skin wheal-like rash in children. In pediatrics, the first choice is the second-generation antihistamine (commonly known as anti-allergic drugs). Commonly used second-generation antihistamine drugs in pediatrics include cetirizine, levocetirizine, loratadine, and deslorata Wait.
Representative drug: After treatment with Claritan
, the symptoms are significantly relieved and the dose can be gradually reduced. When the wheal-like rash completely subsides and there is no recurrence in the near future, the drug can be discontinued as appropriate. Generally, the course of medication is within 1 week. When chronic urticaria exists (pruritic rash symptoms last for more than 6 weeks), the course of antihistamine treatment can be applied for 1 month, and can be extended to 3 to 6 months if necessary (need to follow the advice of a professional doctor).
There are also some children who use second-generation antihistamines at regular doses, but the symptoms of itching and rash cannot be effectively controlled after 1 to 2 weeks. This is seen in some children whose personal constitution is not sensitive to some antihistamines. Combination medication is recommended: combination First-generation antihistamines have drowsiness side effects, so it is recommended to take them before bed to reduce adverse reactions; first-generation antihistamines have obvious effects on the treatment of urticaria, but due to the It has side effects of drowsiness and sedation in children, so it is not the first choice drug for children with urticaria. Commonly used first-generation antihistamines include chlorpheniramine (chlorpheniramine), diphenhydramine, ketotifen, etc. Such as loratadine combined with chlorpheniramine and other treatments.Second-generation antihistamines can also be taken in combination with anti-leukotriene drugs: that is, combined with and Singulair .
Representative drug: chlorpheniramine
Leukotriene receptor antagonist: Singulair
When a child has obvious skin erythema and itching, you can apply topical drugs to relieve itching and symptomatic treatment. For pediatricians, calamine lotion is recommended. Shake well and apply repeatedly. , can help relieve itching.
Children who are ineffective for the above treatments can consider the following treatments. Oral glucocorticoids can be used. It is suitable for acute and severe urticaria. The recommended hormone is prednisone 30 ~ 40 mg (this dose is for adults, children should press Dosage per kilogram of body weight, doctor's advice is required), take orally for 4 to 5 days and then stop taking it, the effect is accurate, but pay attention to hormonal side effects, do not take it orally in large amounts or take it for a long time, you must follow the advice of a professional doctor.
When acute urticaria attacks severely and is accompanied by multiple neurovascular edemas, emergency treatment with intravenous hormones and epinephrine is required to prevent mucosal edema from worsening and affecting the child's throat. Laryngeal edema is a serious condition and can easily lead to suffocation or even death. For example, the child in this case had edema in the eyelids, testicles, and armpits. After we clinically administered methylprednisolone intravenous anti-inflammatory and anti-allergic treatment, the edema gradually reduced and subsided within a few hours.
Therefore, urticaria is not terrible. If you master the correct medication, you can treat the symptoms. With relevant knowledge and experience, you can naturally face your child's itching and discomfort calmly. I hope this article can help you solve your child's disease problems.
Pediatrician Sun Fangzhou, popularizing science and treating diseases correctly.
References: " Chinese Urticaria Diagnosis and Treatment Guidelines (2014 Edition)" Chinese Journal of Dermatology
"Expert Consensus on Diagnosis and Treatment of Allergic Diseases in Children" Chinese Journal of Pediatrics
"Clinical Application of Antihistamines in the Treatment of Allergic Diseases in Infants and Young Children" Expert Consensus》Chinese Journal of Practical Pediatrics
