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: Esther, 19-24 Female (Caregiver) Published: May 09

In 2008 almost the whole year, I had hives and it was the first time. They were on and off. When I took loratadine (Loridin) in 2009, they went but in the last quarter of 2012, they were back. I tried to use the same medication but it could only take away symptoms temporarily. For about 5 months, I have been using raw garlic morning and evening and it works well for me. Also cetirizine was working well for me, for every 1 1/2 days each tab, but only because I wanted to avoid it as it could make me sleepy. Hope you try it out. Good luck.

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Comment from: Cured, 45-54 Female (Patient) Published: June 05

I suffered from chronic hives about 10 years ago. I woke up with hives every morning and anytime I had pressure put on any part of my body. After going to an allergist he found that I had hypothyroidism and Hashimoto's disease. I was put on Claritin for about 6 months while the doctor followed up with regular appointments. After I was hive free for a long period of time he slowly took me off the Claritin and I am still hive free today. The Claritin will make you very sleepy at first but you will adjust if you stick with it. Good Luck!

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