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What is the treatment for hives?
The goal of treating most cases of ordinary acute 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
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. A new treatment recently available for chronic urticaria is the monthly subcutaneous injection
of a monoclonal antibody, omalizumab (Xolair), directed against the IgE receptor on human mast cells.
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.