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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.

A stethoscope on a clinical desk

What parents look for

  • 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.

  • 03

    Independent information

    Pulse Atlas is an independent UK health information library and does not recommend or sell treatment at any clinic.

Indicative pricing

What a private paediatric urticaria clinic costs in London.

Indicative ranges across London private paediatric allergy services.

In short

A first paediatric allergist consultation in London: £350–£650, home the same visit.

Item Indicative range
Initial paediatric allergist consultation £350–£650
Follow-up review £250–£450
Paediatric dietitian (if food-triggered concerns) £150–£280
CSU bloods (FBC, CRP, TFT, coeliac, IgE, thyroid abs) £220–£380
HAE workup (C4, C1-inhibitor level and function) £280–£420
Omalizumab (Xolair) private, per month £950–£1,600

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.

What urticaria is

Hives, in plain English.

A short primer, before the section on what to do about it. If your child has already had months of hives, skip to the pathway options.

  • 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.

  • 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.

  • 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.

When it helps

Situations seen most often in 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.

  • 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.

  • Chronic inducible urticaria

    Cold, cholinergic (exercise, hot showers), dermographism, delayed pressure, solar or aquagenic - triggered by a specific stimulus.

  • 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.

  • Angioedema with the hives

    Swelling of lips, eyelids, hands or feet alongside itchy wheals - almost always histaminergic and antihistamine-responsive.

  • Angioedema without any hives

    Recurrent swellings on their own, without itchy wheals - a different pathway, with screening for hereditary angioedema (HAE).

  • 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.

  • Suspected food trigger

    Chronic urticaria is only rarely food-driven - it should be assessed honestly, avoiding unnecessary elimination diets that can affect growth.

  • 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 at a first consultation is taking 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. Proper testing is better than guessing - and a paediatric dietitian should be involved 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.

  • 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.

  • 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.

  • Chronic inducible urticaria

    Cold, cholinergic, dermographism, delayed pressure, solar or aquagenic. Diagnosed with a targeted challenge. Managed with trigger avoidance plus antihistamine.

  • 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.

  • Angioedema without hives

    Different mechanism. C4, C1-inhibitor level and C1-INH function tests to screen for hereditary or acquired angioedema. Family history matters.

  • 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.

  • 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.

  • 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.

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.

  • 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.

  • 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.

  • Sedating antihistamines are not first-line

    Older sedating antihistamines interfere with sleep quality, learning and behaviour - they are avoided as regular treatment in children.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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, referral to a specialist HAE service follows, 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 UK paediatric allergist reviewing a childhood urticaria clinic letter

A quiet reminder

Allergy language is precise and can read coldly - ask for anything unclear to be put in plain English.

If you would like the letter talked through before your next review, just ask the allergy team.

  1. 01 Header

    Diagnosis and subtype

    Acute versus chronic, spontaneous versus inducible, whether angioedema is present, and whether hereditary angioedema screening is indicated.

  2. 02 Assessment

    History, examination and tests

    Trigger diary summary, drug history, family history, examination findings including dermographism, and any bloods sent with expected turnaround.

  3. 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.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for paediatric allergy consultations and standard bloods is usually funded.

Frequently asked

Quick, honest answers on food triggers, daily antihistamines, insurance, Xolair, remission and angioedema.

  • Does a food trigger need to be checked for?

    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, proper testing is better than guessing.

  • 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, the dose can also be raised to four times the standard age-appropriate dose if a standard dose is not enough.

  • 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.

  • 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 they can be stepped back down to antihistamines alone. Some children need it for longer. Decisions are made review by review, not fixed in advance.

  • 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.

  • What if my child gets swellings but no hives?

    Recurrent angioedema without any wheals is a different pathway. Screening for hereditary angioedema (HAE) uses a C4 level and a C1-inhibitor level and function test, and family history matters - HAE can run in families. If tests suggest HAE, referral to a specialist HAE service is the next step, 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?