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: Paul, 35-44 Male (Patient) Published: February 04

I'm a 35 year old male with hypothyroidism. My doctors cannot pinpoint the reason as to why I get hives but I attribute it to hypothyroidism and a malfunction in hormones. I seem to get hives after meals and more often so in the winter. I use Allegra and in most cases it works. When I have a major attack I use hydroxyzine gel 10 mg. The hydroxyzine works wonders but it knocks you out. It is a very powerful but a quick solution to quashing my hives. If I have a bad attack and my lips swell up, I will dissolve one of the hydroxyzine pills under my tongue for faster absorption.

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Comment from: M, 55-64 Female (Caregiver) Published: March 03

My daughter who is now 32, developed chronic daily hives when she was about 12. Absolutely horrible. They presented every day in the afternoon, and gone by morning. They itched like crazy. We went to numerous specialists for about a year and half until one remembered a connection between hives and low/borderline low thyroid function. She went on a low dose of thyroid hormone and the next day, no hives! She hasn't had them since! This does run in families, however, my husband's niece now has the exact symptoms, as did my husband as a child, who never knew what the cause was. Get to an endocrinologist and have your thyroid checked! Even if it's just borderline low.

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