Hives - Treatment

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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 less 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. 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.

Return to Hives (Urticaria & Angioedema)

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Comment from: kriti, 25-34 Female (Patient) Published: February 12

Urticaria or hives can be cured by Ayurveda. Take celery seeds and jaggery in equal proportions and grind them together. Eat one table spoon daily twice a day, morning and evening or night but empty stomach. Celery seeds can be easily purchased from any Indian grocery store. Do this for 2 to 3 months and it will be cured forever! Besides this, also apply sesame oil on affected area. Also grind mint leaves with sugar in equal quantity and store this paste. Every day take one tablespoon of this paste and mix in water and drink twice a day. I am sure this will help! I was suffering from urticaria, tried multiple medicines but this worked wonders for me. Also there are some foods which aggravate the condition, figure out such foods and stop eating them. In my case it was coffee, figure out yours.

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Comment from: Dorothy, 55-64 Female (Patient) Published: April 12

What works for me for hives until medication starts to kick in is Paxyl, a sunburn relief spray. My son pointed out that it has lignocaine in it. You could probably just buy some lignocaine spray but if you don't have any on hand try the Paxyl, just one short spray works really well.

Was this comment helpful?Yes

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