Your Treatment Options for Hives

With time, chronic hives (your doctor may call them chronic idiopathic urticaria - CIU, or chronic spontaneous urticaria - CSU) usually go away on their own. There’s no medication to cure them, but treatments can help ease your pain and discomfort.

Talk to your doctor about these options:

Antihistamines

These medications block something called histamine. That’s a chemical in the skin that can cause allergy symptoms like hives. The meds come in different forms:

Non-drowsy: Your doctor will probably want you to try over-the-counter options like cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin) first. They won’t make you sleepy. They usually only cause mild side effects, like dry mouth and eyes.

It’s important to take these every day, not just when you have a breakout.

Nighttime: If your hives are severe, your doctor may point you toward diphenhydramine (Benadryl) or a similar medicine. Because it can make you drowsy, your doctor will probably tell you to take it at night.

H2 blockers: You may be told to take more than one type of antihistamine at a time for your hives. Medicines like cimetidine (Tagamet) or famotidine (Pepcid) can be used together with other treatments. These drugs also ease heartburn. For your hives, they narrow blood vessels. That calms redness.

These may cause side effects like diarrhea, dizziness, and headaches.

Steroids

If antihistamines don’t help, your doctor might prescribe a corticosteroid. These drugs calm the immune system. That can make your hives less severe.

You can get them in a shot or a pill. They can cause side effects like:

• High blood pressure
• Weight gain
• Sleep problems
• Bone density problems
• Blurred vision
• The need to pee a lot
• Increased thirst
• Fluid retention
• Psychological effects

Because of the chance of these side effects, doctors usually give them at low doses and only for short periods of time.

If you take these for a while, you could have other side effects, including:

• Cataracts
• High blood sugar
• Higher risk of infection
• Osteoporosis (thinning bones)
• Bruising

Other Options

Chronic hives can be difficult to treat. If there's an underlying cause like a thyroid issue, taking care of that may ease the hives. Often, though, the cause of your reaction can't be found.

When antihistamines and steroids don’t work, there are a few more treatments that your doctor might suggest.

Asthma medications like montelukast (Singulair) or zafirlukast (Accolate) can help hives, including those made worse by aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

These medications can have side effects, so check with your doctor.

Omalizumab (Xolair) is approved for those who don’t get relief from antihistamines. Your doctor injects it under your skin. Experts think it blocks a different chemical in your immune system that contributes to hives.

Dupilumab (Dupixent) is another treatment option for people whose hives continue despite treatment with antihistamines. The FDA recently expanded its approval to include children ages 2 to 11 with chronic spontaneous urticaria whose symptoms continue despite treatment with H1 antihistamines. This makes Dupixent the first biologic approved for younger children with the condition. Dupixent works by blocking proteins that contribute to inflammation.

Side effects of this medication include:

• Headache
• Upset stomach
• A slightly higher chance of heart disease or a stroke
• Rarely, a severe allergic reaction called anaphylaxis

If those drugs don’t work, your doctor may try anti-inflammatory medications or something called an immunosuppressant, which curbs your immune system.

Together, you and your doctor can decide the best treatment plan for your chronic hives.