A child presents with generalized, annular rash with raised wheals and pale centers after strawberry ingestion. Initial treatment?

A child presents with generalized, annular rash with raised wheals and pale centers after strawberry ingestion. Initial treatment?

• A. Aqueous epinephrine 1:1000 subcutaneously
• B. Cetirizine once in clinic and then daily for 2 weeks
• C. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
• D. Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper

Answer: (C)

When a child develops widespread urticaria after a food exposure, the main goal is to block the histamine that drives the itching and wheals. Diphenhydramine, a first‑generation H1 antihistamine, works quickly to relieve pruritus and hives. A practical starting dose is 0.5 to 1 mg/kg per dose every 4 to 6 hours, which provides rapid relief in the acute setting. Epinephrine is reserved for anaphylaxis—airway swelling, throat tightness, wheezing, or shock—so it isn’t the initial treatment here. Prednisone isn’t first-line for uncomplicated acute urticaria because it doesn’t address histamine-driven symptoms as promptly. A second‑generation antihistamine like cetirizine can be useful for ongoing control, but it doesn’t provide the rapid relief needed in this acute presentation.

When a child develops widespread urticaria after a food exposure, the main goal is to block the histamine that drives the itching and wheals. Diphenhydramine, a first‑generation H1 antihistamine, works quickly to relieve pruritus and hives. A practical starting dose is 0.5 to 1 mg/kg per dose every 4 to 6 hours, which provides rapid relief in the acute setting.

Epinephrine is reserved for anaphylaxis—airway swelling, throat tightness, wheezing, or shock—so it isn’t the initial treatment here. Prednisone isn’t first-line for uncomplicated acute urticaria because it doesn’t address histamine-driven symptoms as promptly. A second‑generation antihistamine like cetirizine can be useful for ongoing control, but it doesn’t provide the rapid relief needed in this acute presentation.