Diagnosis

Your doctor will do a physical exam and ask you a number of questions to try to understand what might be causing your signs and symptoms. He or she may also ask you to keep a diary to keep track of:

  • Your activities
  • Any medications, herbal remedies or supplements you take
  • What you eat and drink
  • Where hives appear and how long it takes a welt to fade
  • Whether your hives come with painful swelling

If your physical exam and medical history suggest your hives are caused by an underlying problem, your doctor may have you undergo testing, such as blood tests or skin tests.

Treatment

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. Usually, an effective treatment can be found.

Antihistamines

Taking nondrowsy antihistamine pills daily helps block the symptom-producing release of histamine. They have few side effects. Examples include:

  • Loratadine (Claritin)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)

If the nondrowsy antihistamines don't help you, your doctor may increase the dose or have you try the type that tends to make people drowsy and is taken at bedtime. Examples include hydroxyzine pamoate (Vistaril) and doxepin (Zonalon).

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.

Other medications

If antihistamines alone don't relieve your symptoms, other drugs may help. For example:

  • Histamine (H-2) blockers. These medications, also called H-2 receptor antagonists, are injected or taken orally. Examples include cimetidine (Tagamet HB), ranitidine (Zantac) and famotidine (Pepcid).
  • Anti-inflammation medications. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching. These are generally for short-term control of severe hives or angioedema because they can cause serious side effects if taken for a long time.
  • Antidepressants. The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching. This drug may cause dizziness and drowsiness.
  • 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).
  • Man-made (monoclonal) antibodies. The drug omalizumab (Xolair) is very effective against a type of difficult-to-treat chronic hives. It's an injectable medicine that's usually given once a month.
  • Immune-suppressing drugs. Options include cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraft XL, Prograf, Protopic).

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Chronic hives can go on for months and years. They can interfere with sleep, work and other activities. The following precautions may help prevent or soothe the recurring skin reactions of chronic hives:

  • Wear loose, light clothing.
  • Avoid scratching or using harsh soaps.
  • Soothe the affected area with a bath, fan, cool cloth, lotion or anti-itch cream.
  • Keep a diary of when and where hives occur, what you were doing, what you were eating, and so on. This may help you and your doctor identify triggers.
  • Avoid known triggers.
  • Apply sunscreen before going outside.

Preparing for your appointment

You'll probably first visit your primary care doctor. He or she may refer you to a doctor who specializes in skin diseases (dermatologist) or to an allergy specialist.

For chronic hives, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • How long will these hives last?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Do these treatments have any side effects?
  • Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
  • Does the medicine you're prescribing have a generic version?
  • I have other health problems. Is the treatment you recommend compatible with those conditions?

What to expect from your doctor

Your doctor is likely to ask you questions such as:

  • What symptoms do you have, and when did you first begin experiencing them?
  • Do you have tightness in your chest or throat, nausea, or difficulty breathing?
  • Have you had any viral or bacterial infections recently?
  • What medications, herbal remedies and supplements do you take?
  • Have you tried any new foods recently?
  • Have you traveled to a new place?
  • Do you have a family history of hives or angioedema?
  • What, if anything, appears to improve or worsen your symptoms?
March 06, 2018
References
  1. Hives. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hives. Accessed April 25, 2017.
  2. Hives (urticaria). American College of Allergy, Asthma and Immunology. http://www.acaai.org/allergist/allergies/Types/skin-allergies/hives/Pages/default.aspx. Accessed April 25, 2017.
  3. Khan DA. Chronic urticaria: Standard management and patient education. http://www.uptodate.com/home. Accessed April 25, 2017.
  4. Goldsmith LA, et al., eds. Urticaria and angioedema. In: Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com. Accessed April 25, 2017.
  5. Khan DA. Chronic urticaria: Treatment of refractory symptoms. https://www.uptodate.com/home. Accessed April 25, 2017.
  6. Bernstein JA, et al., eds. The diagnosis and management of acute and chronic urticarial: 2014 update. Journal of Allergy and Clinical Immunology. 2014;133:1270.
  7. Darlenski R, et al. Chronic urticaria as a systemic disease. Clinics in Dermatology. 2014;32:420.
  8. Casale TB. Omalizumab for chronic urticaria. Journal of Allergy and Clinical Immunology: In Practice. 2014;2:118.