Hives - Treatment

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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) and fexofenadine (Allegra) are antihistamines available over the counter that are 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 slightly sedating.

Antihistamines that require a prescription include cyproheptadine (Periactin), which tends to cause drowsiness. A prescription antihistamine that causes little sedation is 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.

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See what others are saying

Comment from: mikey2872, 35-44 Male (Patient) Published: October 22

I get hives during the summer/fall every year. I use OTC Allegra or store generics as maintenance and it seems to keep the hives at bay. I then use Benadryl as the itching breaks through the effect of the Allegra.

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Comment from: Heather, 55-64 Female (Patient) Published: October 31

I was on holiday in Turkey in 2001 when I first started to get a strange reaction. I would feel weak and then my lips started to swell. When we returned home I then started to break out in huge hives and sometimes swelling under the skin. I was sent to numerous specialists and no reason for the hives was found. I tried all the usual drugs mentioned by other people and then one day in 2005, I met a person who had the same problem. She was put on a 5 day dose of prednisone 50mg. a day. At the end of that dose I was then put on hydroxyzine and ranitidine. I took this medication, 1 tablet each morning and evening. This finally worked. I eventually was able to wean myself off this medication and for the past 5 years was hive free - until late this summer when suddenly the hives returned, no known cause. I am trying the same treatment as before but this time I am not getting the same result.

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