Treatments and drugs

By Mayo Clinic Staff

Finding an effective treatment for chronic hives can be challenging. In cases in which a trigger is identified — such as a reaction to a certain food, medication or physical stimulus — treatment includes avoiding the trigger. If your chronic hives are caused by an underlying health condition, they may improve when the underlying condition is treated.

Symptoms can be treated effectively in most people with over-the-counter or prescription medications. Work with your doctor to find the medication — or combination of medications — that works best for you. If the first medication you try doesn't relieve your symptoms, talk to your doctor about trying something else.

Oral antihistamines

These medications block the symptom-producing release of histamine, controlling symptoms for the majority of people with chronic hives — but they do not treat the underlying cause of the rash. Antihistamines are divided into two categories — older, first-generation drugs and newer, second-generation medications. Each category includes nonprescription and prescription drugs. A combination of antihistamines may work best.

Second-generation, newer antihistamines. Your doctor may have you start with newer, nonsedating or low-sedating antihistamines because they are generally as effective and better tolerated than first-generation antihistamines. Examples include:

  • Loratadine (Claritin, Alavert)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
  • Levocetirizine (Xyzal)
  • Desloratadine (Clarinex)

First-generation, older antihistamines. If a nonsedating antihistamine doesn't work, your doctor may recommend taking a first-generation antihistamine. These antihistamines can make you drowsy and impair your ability to drive or perform other tasks that require physical coordination. For that reason, your doctor may recommend that you take this type of antihistamine before bedtime and switch to a second-generation drug during the daytime. This class of antihistamines includes:

  • Hydroxyzine (Vistaril)
  • Diphenhydramine (Benadryl)
  • Chlorpheniramine (Chlor-Trimeton)

Check with your doctor before taking any of these medications if you're pregnant or breast-feeding, have a chronic medical condition, or are taking any other medications.

Other medications

If antihistamines alone don't relieve your symptoms, other possible treatments include:

  • H-2 antagonists. These medications, such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid AC), can be used along with antihistamines. Some common side effects from this class of medications range from gastrointestinal problems to headache.
  • Oral corticosteroids. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching — but are usually used only a short term for severe hives or angioedema because they can cause serious side effects. Topical corticosteroids usually aren't effective for chronic hives. Corticosteroids can weaken your immune system, making it easier for you to get an infection or worsening an existing infection you already have.
  • Tricyclic antidepressants. The tricyclic antidepressant doxepin (Zonalon) has antihistamine properties and can help relieve itching. Doxepin may cause dizziness or drowsiness.

Other medications are still being studied to determine whether they may be useful for treating chronic hives. These include:

  • Leukotriene modifiers. Montelukast (Singulair) and zafirlukast (Accolate) are asthma medications that may be helpful when used along with antihistamines. Side effects of these drugs may include behavior and mood changes.
  • Cyclosporine. This immune system suppressant can help with symptoms, but it can cause serious side effects and needs to be monitored carefully. The Food and Drug Administration warns that taking cyclosporine (Gengraf, Neoral, others) puts you at greater risk of opportunistic infections, such as the activation of a previous infection.
  • Omalizumab (Xolair). This medication is normally given by injection to treat allergic asthma. It may help people who have chronic hives caused by an autoimmune response that haven't been helped by antihistamines. Only very small studies have been completed, so more clinical trials are needed.
Sep. 17, 2011