6yr old son has mild cold urticaria, but getting worse-why? didnt expect it to get worse-suggestions? no hives but swollen itchy skin. takes benadryl (diphenhydramine).

Urticaria, triggers: If there is a change in the pattern or frequency of urticaria, start looking for other triggers, either allergic (pollen or mold allergies, e.g.) or other nonallergic triggers. The latter includes infections (respiratory, GI or urinary tract infections) or use of medications/supplements. Also, Benadryl (diphenhydramine) lasts for only 4-6 hours, he may benefit from longer acting antihistamines, such as loratidine.

Par for the course: Chronic urticaria from any cause may wax and wane with time and thus this is not totally unexpected. If Benadryl (diphenhydramine) does not help, consult an allergist. Be sure to keep him off of ocean or ujnheated pool water in the meanwhile.

Cold urticaria: If your son has not seen an allergist yet, time to see one. I recently diagnosed a young girl with cold urticaria with an underactive thyroid. He needs a good check up.

Needs a good work up: Thyroid disease and sarcoidosis may be associated with skin problems. So there is more than simple allergy. Also, the drug of choice for cold-induced urticaria (if this is really the case for him), is not diphenhydramine (Benadryl) but cyproheptadine (Periactin), Still, needs to see a Board-certified allergist-immunologist.