Treatment for Hives

Mild cases of hives usually resolve without treatment. Treatment for the condition often begins by eliminating the underlying cause (i.e., the trigger). If hives are related to an illness, treating that illness directly usually helps. If the cause for the hives cannot be determined, the rash usually can still be treated.

Several prescription and over-the-counter (OTC) medications can be used to treat hives. In some cases, a combination of medicines is used. Treatment for urticaria may include the following medications:

Topical creams and lotions (e.g., containing camphor, menthol, dipenhydramine, or pramoxine) can be used to relieve itching.

Oral antihistamines (e.g., loratadine [Claritin], fexofenadine [Allegra], cetirizine [Zyrtec®], diphenhydramine [Benadryl®], hydroxyzine [Vistaril®], chlorpheniramine [Chlor-Trimeton®]), which block the production of histamine, can help reduce symptoms of hives. However, these medications do not treat the underlying cause for the condition.

Oral antihistamines can be used alone or in combination with another medication (e.g., an H-2 antagonist). Dosing instructions vary, and some patients need to take medicine daily for several days until the hives resolve completely. Physicians usually prescribe a non- or low-sedating antihistamine (e.g., Claritin) first, and then, if this medication is not effective, a more sedating antihistamine (e.g., Benadryl), may be used.

H-2 antagonists (e.g., cimetidine [Tagamet®], famotidine [Pepcid® AC], ranitidine [Zantac®]) may be used either alone or in combination with an antihistamine to treat hives.

Corticosteroids (e.g., prednisone) act quickly and can be used on a short-term basis to treat hives. Prednisone helps to relieve swelling, redness, and itching, and also can prevent hives from coming back. In severe cases, corticosteroids may be given by injection or intravenously (i.e., in an IV). These drugs can cause severe side effects, so they are used with caution and at the lowest effective dose.

Tricyclic antidepressants (e.g., doxepin [Zonalon®]) can help relieve itching caused by hives.

Epinephrine (adrenaline injection) may be used in emergency situations to prevent anaphylactic shock. Patients who have frequent, severe allergic reactions may carry an EpiPen® to inject themselves if necessary. Emergency treatment for severe cases of hives might also include IV fluids and other medications to increase blood pressure and oxygen to help with breathing.

The main side effect associated with hive medications is drowsiness, which often becomes less severe over time. Patients should use these drugs with caution and should avoid activities that require mental alertness (e.g., driving a car, operating power tools) while taking them. Many people choose to take hive medication at bedtime.

In addition to drowsiness, antihistamines also may cause constipation, dizziness, runny nose, and stomach upset. Side effects of corticosteroids include indigestion, increased or decreased appetite, and nervousness. Corticosteroids must be discontinued slowly and if these medications are used for a long period of time, severe side effects such as abdominal pain, changes in vision, and muscle weakness can result. Epinephrine side effects include headache, blurred vision, and restlessness. Patients who experience severe medication side effects should contact a physician immediately.

Other Treatments for Hives

In some cases, itching and other hive symptoms can be relieved be placing a cool compress on the skin, taking a cool bath or shower, or wearing lightweight, loose-fitting clothing. Relaxation and stress management techniques may also be helpful, as well as avoiding hot baths and showers, sunlight, and physical activity.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 16 Aug 2009

Last Modified: 07 Sep 2010