Hives (cont.)
What is the treatment for hives?
The goal of treating most cases of ordinary urticaria is
to relieve symptoms while the condition goes away by itself. The most commonly used oral treatments
are antihistamines, which help oppose the effects of the histamine leaked by
mast cells. The main side effect of antihistamines is drowsiness.
Many antihistamines are available without prescription, such as
diphenhydramine (Benadryl), taken in doses of 25 milligrams and chlorpheniramine
(Chlor-Trimeton), taken in a dose of 4 milligrams. These can be taken up to three times a day, but because these medications can cause drowsiness, they are often taken at bedtime. Those who take them should be especially careful and be sure they are fully alert before driving or participating in other activities requiring mental concentration.
Loratadine (Claritin, 10 milligrams) is available over-the-counter and is less likely to cause drowsiness. Also approved for over-the-counter use is
cetirizine (Zyrtec, 10 milligrams), which is mildly sedating. Some antihistamines come bundled with decongestant medication (Claritin-D, Zyrtec-D). The decongestant component is not needed to treat hives.
Antihistamines that require a prescription include hydroxyzine (Atarax, Vistaril) and cyproheptadine, both of which tend to cause drowsiness. Prescription antihistamines that cause little sedation are
fexofenadine (Allegra) and levocetirizine (Xyzal). Sometimes physicians combine these with other types of antihistamines called H2 blockers, such as ranitidine (Zantac) and cimetidine (Tagamet).
This antihistamine list is not exhaustive. Physicians individualize treatment plans to suit specific patients and modify them depending on the clinical response.
Oral steroids (prednisone, [Medrol]) can help severe cases of hives in the short-term, but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. Other treatments have been used for urticaria as well, including montelukast (Singulair), ultraviolet radiation, antifungal antibiotics, agents that suppress the immune system, and tricyclic antidepressants (amitriptyline [Elavil, Endep], nortriptyline [Pamelor, Aventyl], doxepin [Sinequan, Adapin]). Evidence to support the benefit of such treatments is sparse. In ordinary cases they are rarely needed.
Topical therapies for hives include creams and lotions which help numb nerve endings and reduce itching. Some ingredients which can accomplish this are
camphor, menthol, diphenhydramine, and pramoxine. Many of these
topical preparations require no prescription. Cortisone-containing creams
(steroids), even strong ones needing a prescription, are not very helpful in
controlling the itch of hives.
Conclusion
To know exactly what kind of hives you have, or to learn
more about research into the immune basis of hives or about rarer forms of this
condition, you should consult your physician. It is important, however, to keep
in mind that
most cases of this common disorder represent either ordinary urticaria or
physical urticaria, which are annoying but not serious or allergic, and almost
always temporary.
Last Editorial Review: 1/23/2008
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