Paediatric allergy · London
Paediatric urticaria clinic - London.
A private clinic for children with chronic hives, angioedema and physical urticaria - led by a consultant paediatric allergist, with a clear medication ladder from antihistamine up-dosing to omalizumab (Xolair), and an honest steer on whether food is really the trigger.
Why parents choose us
- 01
A named paediatric allergist, not a general list
A consultant who runs a dedicated childhood urticaria service, not a general paediatric or dermatology clinic that also sees the odd hive.
- 02
The right pathway, first time
Antihistamine up-dosing, montelukast, omalizumab Xolair or HAE workup when angioedema is unexplained. We match your child to the pathway that fits.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private paediatric urticaria clinic costs in London.
Indicative ranges across our London paediatric allergy partners. Send a short history and we quote firm figures across two options.
In short
A first paediatric allergist consultation in London: £350–£650, home the same visit.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial paediatric allergist consultation | £350–£650 | 45–60 min | Same visit |
| Follow-up review | £250–£450 | 30 min | Same visit |
| Paediatric dietitian (if food-triggered concerns) | £150–£280 | 45 min | Same visit |
| CSU bloods (FBC, CRP, TFT, coeliac, IgE, thyroid abs) | £220–£380 | 15 min | 3–5 days |
| HAE workup (C4, C1-inhibitor level and function) | £280–£420 | 15 min | 7–10 days |
| Omalizumab (Xolair) private, per month | £950–£1,600 | 30 min | Monthly |
Prices vary by hospital, by the seniority of the paediatric allergist, and by which bloods and biologics are used. Omalizumab (Xolair) is monthly and needs pre-authorisation with most insurers. We come back with a firm quote within one working day.
What urticaria is
Hives, in plain English.
A short primer, before we get to what to do about it. If your child has already had months of hives, skip to the pathway options.
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Raised, itchy wheals
Individual hives are raised, pink or pale, intensely itchy and last less than 24 hours in any one spot. They fade without scarring and often migrate to a new area.
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Acute versus chronic
Acute urticaria lasts less than six weeks and is usually viral or drug-related in children. Chronic urticaria is daily or near-daily hives lasting six weeks or more.
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Spontaneous versus induced
Chronic spontaneous urticaria (CSU) has no obvious trigger. Chronic inducible urticaria is set off by a specific stimulus - cold, pressure, exercise, sunlight, water.
The journey
From enquiry to a settled plan - what happens, in order.
One team from first message to review - including the medication ladder and, if you need it, the biologic pathway.
Phase 1 · Before the appointment
Concierge, off-stage for you
Phase 2 · On the day
Under an hour at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You send us a short history
When the hives started, how many days a week, any obvious trigger, medications tried, and photos of a typical flare if you have them.
- 02
Before
We come back with a recommendation
Within one working day: which paediatric allergist fits, whether Xolair is likely to be on the table, and indicative cost across two options.
- 03
Before
We book the consultation
Usually within one to two weeks. Bring the trigger diary, the medication list and any photos or videos of active lesions.
- 04
On the day
Arrival at the clinic
A relaxed paediatric setting. A detailed history with parent and child, examination, a dermographism test, and bloods only if the story calls for them.
- 05
On the day
The plan is agreed with you
Antihistamine dose written down, when to up-dose, when to call, and whether omalizumab or HAE workup is next if things do not settle.
- 06
On the day
You go home the same visit
Written aftercare, a symptom diary and, where relevant, a rescue plan for angioedema. No overnight stay.
- 07
After
Review and step-up if needed
A follow-up at 4 to 6 weeks. Blood results discussed. If antihistamines up to four times standard dose are not working, we plan the biologic pathway.
Typical end-to-end: 1–2 weeks to first appointment. Review: 4–6 weeks. Xolair review: 6 months.
When it helps
Situations we see most in the clinic.
If any of these sound like your child, a paediatric allergy assessment will give you a clear treatment ladder and, importantly, a rescue plan.
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Chronic spontaneous urticaria (CSU)
Daily or near-daily hives for six weeks or more with no obvious trigger - the commonest chronic urticaria in older children and teens.
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Chronic inducible urticaria
Cold, cholinergic (exercise, hot showers), dermographism, delayed pressure, solar or aquagenic - triggered by a specific stimulus.
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Post-viral acute urticaria that will not go
A viral illness that has settled but the hives keep coming for weeks - very common in younger children and usually self-limiting.
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Angioedema with the hives
Swelling of lips, eyelids, hands or feet alongside itchy wheals - almost always histaminergic and antihistamine-responsive.
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Angioedema without any hives
Recurrent swellings on their own, without itchy wheals - a different pathway, and we screen for hereditary angioedema (HAE).
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Antihistamine at standard dose not working
A child on a licensed dose of cetirizine, loratadine or fexofenadine who is still flaring most days - up-dosing is the next step, not more sedating medicines.
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Suspected food trigger
Chronic urticaria is only rarely food-driven - we assess honestly and avoid unnecessary elimination diets that can affect growth.
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Red flag: anaphylaxis features
Wheeze, throat tightness, drop in blood pressure or collapse alongside hives is anaphylaxis - call 999 and use adrenaline. Not a routine clinic booking.
A quiet word on food
Chronic hives in children are rarely a food allergy.
One of the most important things we do at first consultation is take the pressure off the family kitchen - and off the child.
Only 1–3% are actually food-driven
Only around one to three per cent of chronic urticaria in children is triggered by a specific food. When food is the culprit, it usually shows itself as an acute reaction within minutes of a specific meal, often with lip swelling, cough or wheeze - not as a rolling, daily rash.
Blanket exclusion can harm growth
Cutting out milk, wheat, eggs and nuts without evidence rarely improves the hives and can make a child anxious around food. It can also affect calories, iron, calcium and protein intake. We test properly rather than guess - and we bring in a paediatric dietitian if changes are genuinely needed.
Pathway options
The treatment ladder - antihistamine to biologic.
Most children will settle on step one or two. The point of the clinic is to move up the ladder quickly and safely when the earlier steps are not enough - not to leave a child scratching for a year.
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Acute urticaria (<6 weeks)
Post-viral, drug-related or occasionally a genuine IgE food allergy. Usually settles within days to weeks on a regular non-sedating antihistamine.
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Chronic spontaneous urticaria (CSU)
Six weeks or more of daily hives with no clear trigger. Autoimmune in many older children. Antihistamine up-dosing first, then omalizumab if needed.
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Chronic inducible urticaria
Cold, cholinergic, dermographism, delayed pressure, solar or aquagenic. Diagnosed with a targeted challenge. Managed with trigger avoidance plus antihistamine.
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Angioedema with hives
Histamine-mediated swellings that come and go with the wheals - the same treatment ladder as CSU, with a written rescue plan for larger swellings.
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Angioedema without hives
Different mechanism. C4, C1-inhibitor level and C1-INH function tests to screen for hereditary or acquired angioedema. Family history matters.
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Antihistamine up-dosing
Per EAACI paediatric CSU guidelines, non-sedating antihistamine can be up-dosed to four times the standard age-appropriate dose before adding another agent.
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Add-on montelukast or H2
A leukotriene receptor antagonist or an H2 antihistamine (famotidine) added on when up-dosed H1 antihistamine alone is not enough.
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Omalizumab (Xolair) biologic
Anti-IgE injection every four weeks for children over six with CSU that has not responded to antihistamines. NICE-approved (TA339) and highly effective.
Our vetted London network
A small panel of paediatric allergists, we picked them.
Consultant paediatric allergists with a dedicated urticaria service, at The Portland Hospital Paediatric Allergy, HCA The Wellington Paediatric Allergy and Dermatology, Great Ormond Street International & Private Care, and Chelsea and Westminster Private Care.
Selection criteria
How we choose every paediatric allergist in our network.
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Consultant paediatric allergists running a dedicated childhood urticaria service
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Access to omalizumab (Xolair) for licensed CSU in children aged six and over
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HAE screening pathway with C4, C1-inhibitor level and function testing
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Paediatric dietitian on the same site where food-triggered assessment is needed
Safety and treatment
What treatment looks like - honestly.
Treating paediatric urticaria is about steady daily control, not chasing rescue medications. The framework below is the same one you will hear in clinic.
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Non-sedating antihistamine, taken daily
Cetirizine, loratadine or fexofenadine at the standard age dose is the first-line treatment. Taken regularly, not just when the hives are visible.
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Up-dosing is safe and evidence-based
EAACI paediatric CSU guidelines allow up-dosing a non-sedating antihistamine to four times the standard dose if symptoms persist. Discussed and written down.
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Sedating antihistamines are not first-line
Older sedating antihistamines interfere with sleep quality, learning and behaviour - we avoid them as regular treatment in children.
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Short oral steroid for severe flares only
A short course of oral prednisolone can settle a very severe flare, but repeated steroids in children are avoided in favour of stepping up the ladder.
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Omalizumab (Xolair) is well-tolerated
A subcutaneous injection every four weeks. Licensed for CSU from age six. Injection-site reactions are the commonest side effect; serious reactions are rare.
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Food restriction rarely helps chronic hives
Only one to three per cent of chronic urticaria in children is driven by a specific food. Blanket exclusion diets can harm growth and are not routinely advised.
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Rescue plan for angioedema swellings
A written plan: when a swelling can be watched at home, when to double the antihistamine, and when to seek same-day review or attend A&E.
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Adrenaline auto-injector, when indicated
Not routinely needed for isolated chronic urticaria. Prescribed only where there is a coexisting anaphylaxis risk - and only with proper training.
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Red flags after discharge
Wheeze, difficulty breathing, throat tightness, tongue swelling, drowsiness or collapse - call 999 and use adrenaline if prescribed. Do not wait for the clinic.
Angioedema without hives
When it is swellings alone - think about hereditary angioedema.
Recurrent swellings without itchy wheals behave differently from ordinary urticaria and need a different set of tests.
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A different mechanism
These swellings are driven by bradykinin, not histamine, so antihistamines and adrenaline often do not work well - which is a big clue.
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The right blood tests
We check C4, C1-inhibitor level and C1-inhibitor function. A low C4 with abnormal C1-INH points strongly to hereditary or acquired angioedema.
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Family history matters
Hereditary angioedema (HAE) runs in families in most cases. A parent, sibling or grandparent with unexplained swellings is an important part of the story.
If tests suggest HAE we refer on to a specialist HAE service, where modern treatments (C1-INH concentrate, icatibant, lanadelumab) sit alongside a written attack plan.
Reading your clinic letter
Your clinic letter in four parts. Read the last one first.
Whichever allergist your child sees, the letter that comes home tends to keep to the same shape.
A quiet reminder
Allergy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your next review, just ask.
- 01 Header
Diagnosis and subtype
Acute versus chronic, spontaneous versus inducible, whether angioedema is present, and whether hereditary angioedema screening is indicated.
- 02 Assessment
History, examination and tests
Trigger diary summary, drug history, family history, examination findings including dermographism, and any bloods sent with expected turnaround.
- 03 Plan
The medication ladder
Which antihistamine at what dose, when to up-dose to two, three or four times standard, and the trigger point for adding montelukast, famotidine or omalizumab.
- 04 Impression
Follow-up and rescue plan
Read this first: when the next review is booked, what to do for a bad flare, and when to attend A&E for angioedema or breathing symptoms.
Recognised by major UK insurers
Cover for paediatric allergy consultations and standard bloods is usually funded. Omalizumab (Xolair) needs pre-authorisation with most insurers - we handle it.
Frequently asked
Everything parents ask us about children's hives.
Quick, honest answers on food triggers, daily antihistamines, insurance, Xolair, remission and angioedema.
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Do we need to check for a food trigger?
For chronic urticaria - hives on most days for six weeks or more - a food trigger is uncommon. Only one to three per cent of children with chronic urticaria are actually food-driven, and even then episodes usually come with other IgE features like lip swelling within minutes of a specific food. A blanket exclusion diet can affect growth and rarely helps. If the story sounds food-linked we will test properly rather than guess.
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Is a daily antihistamine safe for a child long term?
Yes. Non-sedating antihistamines like cetirizine, loratadine and fexofenadine have a strong safety record in children when taken daily for months at a time. They are safer than repeated courses of oral steroid. In line with EAACI paediatric CSU guidelines, we can also up-dose to four times the standard age-appropriate dose if a standard dose is not enough.
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Will private health insurance cover the clinic?
Most UK insurers cover a paediatric allergist consultation and standard workup for chronic urticaria when a GP referral confirms medical need. Cover for omalizumab (Xolair) varies - some insurers fund it in line with NICE TA339 criteria, others require pre-authorisation. We check cover before booking so there are no surprises.
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How long does a child stay on Xolair?
Omalizumab is usually given every four weeks and reviewed at six months. Many children come off it after nine to twelve months of good control, either because the CSU has gone into remission or because we can step them back down to antihistamines alone. Some children need it for longer. Decisions are made review by review, not fixed in advance.
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Will my child grow out of chronic urticaria?
Most children do. Around half of paediatric chronic spontaneous urticaria settles within one to three years, and a further group settle over five years. Chronic inducible urticarias - cold, cholinergic, dermographism - can be more persistent. The point of treatment is to keep your child comfortable and living normally while the condition runs its course.
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What if my child gets swellings but no hives?
Recurrent angioedema without any wheals is a different pathway. We screen for hereditary angioedema (HAE) with a C4 level and a C1-inhibitor level and function test, and we take a family history seriously - HAE can run in families. If tests suggest HAE we refer on to a specialist HAE service, because the treatment is completely different from ordinary urticaria.
Related pathways
Looking for something else for your child?
If the picture is not quite chronic urticaria, one of these pathways may be a closer fit. Not sure? Send us a short history and we will point you in the right direction.
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Skin prick allergy testing (paediatric)
Quick, painless testing for the common inhalant and food allergens in children.
Learn more -
Component-resolved allergy testing (ISAC / ALEX)
A blood test that separates high-risk from low-risk allergen components.
Learn more -
Anaphylaxis management and EpiPen training
A written emergency plan and hands-on training with an adrenaline auto-injector.
Learn more -
Baby and toddler allergy assessment
Structured assessment for eczema, weaning reactions and suspected food allergy under three.
Learn more -
Paediatric drug allergy clinic
Testing and de-labelling for suspected antibiotic and NSAID allergy in children.
Learn more -
Eczema (atopic dermatitis)
The condition guide - because eczema and urticaria often travel together.
Learn more