Your doctor will likely recommend you treat your symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps don't help, talk with your doctor about finding the prescription medication or combination of drugs that works best for you.
Treat any underlying factors causing your symptoms. If your doctor can determine that your hives are caused by another condition, he or she will first try to treat that. For example, people with chronic hives and inflamed thyroid (thyroiditis) may best be helped by treating the thyroid problem.
Take nondrowsy forms of antihistamine pills. Taking antihistamines pills daily helps block the symptom-producing release of histamine. The newer forms of the drugs (second-generation antihistamines) have fewer side effects, such as drowsiness, than older antihistamines:
- Loratadine (Claritin, Alavert)
- Fexofenadine (Allegra)
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Desloratadine (Clarinex)
Take older forms of antihistamine pills. If the newer antihistamines don't help you, your doctor may recommend you take an older form of the drug, but only before bedtime, as it can make you drowsy. Examples include:
- Hydroxyzine (Vistaril)
- Diphenhydramine (Benadryl)
- Chlorpheniramine (Chlor-Trimeton)
Check with your doctor before taking any of these medications if you are pregnant or breast-feeding, have a chronic medical condition, or are taking other medications.
Try other medications. If antihistamines alone don't relieve your symptoms, other drugs that may help include:
- Histamine (H-2) blockers. These medications, also called H-2 receptor antagonists, may be injected or taken orally. Examples include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid). Side effects range from digestive problems to headache.
Anti-inflammation medications. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching. These usually are used only for a short time to control severe hives or angioedema because they can cause serious side effects.
Corticosteroids creams applied to the skin 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 infection you already have.
- Antidepressants. The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.
Ask about other options. Several medications under study show promise for people whose chronic hives resist treatment:
June 13, 2014
- An injectable asthma drug. Several studies show the drug omalizumab (Xolair) is very effective against difficult-to-treat chronic hives, without side effects. But it is more costly than other options and is not usually covered by insurance.
- Asthma drugs with antihistamines. Medications that interfere with the action of leukotriene modifiers may be helpful when used with antihistamines. Examples are montelukast (Singulair) and zafirlukast (Accolate). Side effects may include behavior and mood changes.
- Cyclosporine. The drug cyclosporine (Gengraf, Neoral, others) affects the immune system and provides relief from chronic hives. Possible side effects range from headache and nausea to an increased risk of infection and reduced kidney function.
- Tacrolimus. Similar to cyclosporine, this drug reduces the immune system response that causes hives. And it, too, may cause a range of side effects, from minor to serious.
- Mycophenolate. This immune-suppressing drug also improves hives signs and symptoms. But for pregnant women, it increases the risk of miscarriage and birth defects.
- Hives. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hives. Accessed Jan. 29, 2014.
- Hives (urticaria). American College of Allergy, Asthma and Immunology. http://www.acaai.org/allergist/allergies/Types/skin-allergies/hives/Pages/default.aspx. Accessed Jan. 29, 2014.
- Khan DA. Chronic urticaria: Standard management and patient education. http://www.uptodate.com/home. Accessed Jan. 29, 2014.
- Goldsmith LA, et al., eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=740. Accessed Jan. 29, 2014.
- Khan DA. Chronic urticaria: Treatment of refractory symptoms. http://www.uptodate.com/home. Accessed Feb. 3, 2014.
- Bolognia JL, et al. Dermatology. 3rd ed. Philadelphia, Pa.: Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 29, 2014.
- Uysal P, et al. An algorithm for treating chronic urticaria with omalizumab: Dose interval should be individualized. Journal of Allergy and Clinical Immunology. In press. Accessed Jan. 30, 2014.
- Saini SS. Chronic spontaneous urticaria: Etiology and pathogenesis. Immunology and Allergy Clinics of North America. 2014;34:33.
- Kaplan A, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. Journal of Allergy and Clinical Immunology. 2013;132:101.
- Darlenski R, et al. Chronic urticaria as a systemic disease. Clinics in Dermatology. In press. Accessed Jan. 30, 2014.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 30, 2014.
- Casale TB. Omalizumab for chronic urticaria. Journal of Allergy and Clinical Immunology: In Practice. 2014;2:118.
- Khan DA. Alternative agents in refractory chronic urticaria: Evidence and considerations on their selection and use. Journal of Allergy and Clinical Immunology: In Practice. 2013;1:433.
- Metz M, et al. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: A retrospective clinical analysis. Journal of Dermatological Science. 2014;73:57.
- Pizzorno JE, et al. Textbook of Natural Medicine. 4th ed. St. Louis, Mo.: Churchill Livingstone Elsevier; 2013. http://www.clinicalkey.com. Accessed Jan. 31. 2014.
- Sussman G, et al. Real-life experiences with omalizumab for the treatment of chronic urticaria. Annals of Allergy, Asthma and Immunology. In press. Accessed Jan. 31, 2014.
- Neuropsychiatric events with certain asthma drugs. FDA Patient Safety News: Show #89, August 2009. U.S. Food and Drug Administration. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/printer.cfm?id=1050. Accessed Feb. 6, 2014.
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