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February 10, 2012

Hives (cont.)

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Are there other conditions that mimic hives?

There are other rashes that may look like hives but the fact that they remain stable and do not resolve within 24 hours is helpful in distinguishing them from hives. Such rashes may need to be biopsied (a small sample of skin is taken and examined under the microscope) to accurately determine the nature of the skin disease.

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 an antihistamine available over the counter that is less likely to cause drowsiness. Also approved for over-the-counter use is hydroxyzine (Atarax, Vistaril), which causes drowsiness, and its breakdown product, cetirizine (Zyrtec, 10 milligrams), which is mildly sedating.

Antihistamines that require a prescription include cyproheptadine (Periactin), which tends 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 are available but are generally ineffective. They 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 requiring 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 are almost always temporary.

Hives At A Glance
  • Hives (medically known as urticaria) are red, itchy, raised areas of skin that appear in varying shapes and sizes.
  • Hives are very common and most often their cause is elusive.
  • Hives can change size rapidly and to move around, disappearing in one place and reappearing in other places, often in a matter of hours.
  • Ordinary hives flare up suddenly.
  • Physical hives are hives produced by direct physical stimulation of the skin.
  • Treatment of hives is directed at symptom relief while the condition goes away on its own.
  • Antihistamines are the most common treatment for hives.
  • Hives typically are not associated with long-term or serious complications.

Additional resources from WebMD Boots UK on Hives

REFERENCES:

Bolognia, Jean L., Joseph L. Jorizzo, and Ronald P. Rapini. Dermatology. 2nd ed. Spain: Mosby, 2008.

Frigas, Evangelo, and Miguel A. Park. "Acute Urticaria and Angioedema." Am J Clin Dermatol 10.4 (2009): 239-250.

Kaplan, A.P., and M. Greaves. "Pathogenesis of Chronic Urticaria." Clinical & Experimental Allergy 39 (2009): 777-787.


Last Editorial Review: 3/24/2011


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