Urticaria | Nestlé Health Science
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Baby with hives

Urticaria is a common skin condition characterised by well-circumscribed, intensely pruritic, oedema of the superficial skin, typically one or two cm in diameter, although they can vary in size and coalesce to form a large raised wheal.1 Urticaria can occur on any part of the skin1 and is more often acute than chronic.2

What causes urticarial in infants?

The most common causes of acute urticaria in infants include food allergens, such as cow’s milk protein. Exposure to insect bites, medication, or infection can also result in urticaria.1 The possible causes of urticaria can often be identified in infants with acute urticaria, although the specific trigger can only be found in 10–20% of chronic cases. 3

Urticaria as a symptom of Cow’s Milk Protein Allergy

Urticaria is one of the many cutaneous symptoms of Cow’s Milk Protein Allergy (CMPA)4.  Urticaria has been reported to occur as a symptom of CMPA in almost 30% of infants and usually appears as early reaction to the ingestion of cow’s milk protein.5,6


The majority of infants affected with CMPA have at least two symptoms affecting at least two different organ systems.4,7  If, in addition to urticaria, your patient shows any of the signs and symptoms that can be related to CMPA9 8 (see below), you can use the CoMiSS® tool 9 to score the combination of their symptoms and assess the likelihood of CMPA.

Signs and symptoms related to CMPA8

  • Gastrointestinal/Digestive: Colic, vomiting, reflux, regurgitation, anorexia, diarrhea, constipation
  • Respiratory: Chronic cough, sneezing, wheezing, runny nose
  • Skin: Atopic dermatitis, rash
  • General: Failure to thrive, anaphylaxis, insomnia, inconsolable crying

How to score this symptom with the CoMiSS® tool

·         The presence of urticaria is scored: no=0, yes=6

·         In addition to the skin symptoms score, if any of the following signs or symptoms related to CMPA are present, they should also be given a score using the CoMiSS® tool. These include crying, diarrhea, constipation, regurgitation, skin (atopic dermatitis) and respiratory symptoms

CoMiSS® awareness tool

The Cow’s Milk-related Symptom Score (CoMiSS)® is a simple, fast and easy-to-use awareness tool designed to help you more easily recognise the signs and symptoms that can be cow’s milk-related in infants and young children.

CoMiSS® awareness tool is available in print and online version
If you suspect your patient is suffering from symptoms that may be suggestive of CMPA, use the CoMiSS® tool to score and assess the likelihood of CMPA.

Other Symptoms of Cow's Milk Protein Allergy


1.    Schaefer P. An Fam Physician 2011 May 1;83 (9): 1078-84

2.    Deadcock SJ. Clin Exp Immunol. 2008;153(2):151-61

3.    Kulthanan K., et al. J Dermatol. 2007;34(5): 294–301

4.    Lifschitz C and Szajewska H. Eur J Pediatr. 2015;174:141–50

5.    Hill DJ., et al. Clin Allergy 1988;18(5)481-90

6.    Vandenplas Y., et al Arch Dis Child 2007;92:902-08

7.    Høst A. Pediatr Allergy Immunol. 1994;5:1–36

8.    Koletzko S., et al. J Pediatr Gastroenterol Nutr. 2012;55(2):221–9

9.    Vandenplas Y., et al. Acta Paed. 2015;104:334–39

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.