Hives are a common skin condition that affects up to 20% of people at some point in their lives. While many hives go away on their own without treatment, others may require medications and treatments. Treatment options largely depend on the underlying cause and can include over-the-counter antihistamines, corticosteroids, anti-inflammatory drugs, monoclonal antibodies, or even a simple cooling bath.
Most cases of acute urticaria are associated with allergies. Chronic hives (hives that last more than six weeks or that recur for months or years) are believed to be caused by an autoimmune response. In both cases, hives are caused by a substance or condition to which the body responds abnormally.
The reaction can be caused by a number of factors, including food, medicine, pollen, insect bites, or latex. Even certain physical triggers, such as heat, cold, pressure, sun, exercise, and vibration, can deactivate the immune response, leading to the formation of hives .
To alleviate it, it may be enough to simply pull the trigger. In general, acute hives go away on their own and usually go away within hours to days without treatment.
If the hives are particularly itchy, a wet cold compress can be used to soothe the itching and reduce the swelling. The easiest way to do this is to dip a cloth in a bowl of ice water and apply it directly to the skin.
To further reduce discomfort, wear loose cotton or soft, lightweight synthetic fabrics like rayon. Avoid wool, linen, denim, or any textured fabric that can irritate your skin. You should also avoid overheating, as this can make your symptoms worse. And whatever you do, don't scratch yourself.
Antihistamines are the best first-line remedy for hives. These medications work by suppressing histamine , a chemical produced by the immune system that causes allergy symptoms. For most types of hives, over-the-counter antihistamines can provide significant relief.
Unlike older generation antihistamines, newer drugs generally do not cause drowsiness and can last up to 24 hours. They include:
Side effects are usually mild and include dizziness, dry mouth, nausea, constipation, and cough.
Benadryl (diphenhydramine) , an older antihistamine, is generally not recommended for daytime use due to its sedative effect, but it can help you sleep if the itchiness is keeping you awake.
Histamine H2 receptor antagonists, also known as H2 blockers, are another class of drugs that are sometimes used in conjunction with antihistamines. H2 blockers, generally prescribed to treat heartburn, constrict the blood vessels in the skin, thereby relieving redness and inflammation. These include popular over-the-counter brands such as:
- Tagamet (cimetidine)
- Pepcid (famotidine)
Uncommon side effects include headache, dizziness, diarrhea, muscle pain, joint pain, and a rash.
For some chronic forms, other medications may be required, especially if the cause is a physical factor and not an allergy.
Over-the-counter antihistamines may not be strong enough to treat all forms of hives.
Commonly used prescription medications include antihistamines, corticosteroids, leukotriene modifiers, and monoclonal antibodies approved specifically for the treatment of chronic urticaria.
Clarinex (desloratadine) is an antihistamine similar to Claritin and Zyrtec, but it is only available by prescription.
If antihistamines that don't cause drowsiness don't work, your healthcare provider may prescribe Vistaril (hydroxyzine pamoate) to take before bed. It is a stronger antihistamine used to treat a wide range of skin reactions, including chronic hives, contact dermatitis, and histamine-related pruritus (pruritus).
Hydroxyzine is sedating in most patients and can cause falls and confusion in the elderly. Less common side effects can include headache, upset stomach, and blurred vision.
If antihistamines don't work even in higher doses or cause excruciating side effects, your doctor may prescribe corticosteroids to quickly reduce the swelling and itching.
Corticosteroids can weaken the immune system in general. Therefore, regardless of whether the cause is allergic or autoimmune (both are mediated by the immune system), these medications can "reduce" symptoms when other medications cannot.
For this, prednisone is most often prescribed, which can be administered in the form of injections or in the form of tablets.
Corticosteroids should only be used for short-term treatments due to the risk of serious side effects, such as osteoporosis, glaucoma, and diabetes.
Leukotriene modifiers work by stopping or decreasing the production of leukotrienes, substances that can narrow the airways and cause inflammation.
By mitigating the latter effect, leukotriene modifiers have been shown to be helpful in some cases of hives, although the FDA has not labeled this class of drugs for use in hives.
Montelukast is among the medications that have a black box warning on their labels due to potential neuropsychiatric side effects.
Singular (montelukast) is the most commonly used leukotriene modifier and is used off-label in the treatment of hives.
Common side effects of leukotriene modifiers include headache, nausea, vomiting, insomnia, and irritability.
Doxepin is a tricyclic antidepressant that also acts as a powerful antihistamine. When given in low doses, doxepin can be extremely effective in treating persistent urticaria of unknown origin (called chronic idiopathic urticaria).
Side effects include drowsiness, dry mouth, dehydration, headache, fatigue, dizziness, and mood swings.
Doxepin should be used under medical supervision, as it is known to induce suicidal ideation in children and young adults with a history of depression or other mental illnesses.
Doxepin is sold under a variety of brand names including Silenor, Zonalon, and Prudoxin.
Xolair ( omalizumab ) is an injectable medication originally prescribed for people with asthma who have not responded to corticosteroids. More recently, it has been approved for the treatment of chronic idiopathic urticaria when all other treatments have failed.
Xolair is a monoclonal antibody that blocks a protein known as immunoglobulin E (IgE), which plays a central role in allergies and some types of hives and dermatitis. That said, scientists are not entirely sure how Xolair works, as most chronic hives are not associated with any particular IgE-mediated allergy.
Common side effects include swelling and pain at the injection site, cough, dizziness, tiredness, heart palpitations, and chest tightness.
Hives Discussion Guide for Healthcare Providers
Get our printed guide to your next doctor's appointment to help you ask the right questions.
Complementary Medicines (CAM)
Although many complementary and alternative drugs (CAMs) have been proposed for the treatment of acute and chronic urticaria, the evidence is still weak. This is especially true in the case of chronic urticaria, the condition of which we do not yet fully understand.
In addition to potentially not having any benefit, some complementary and alternative medications can aggravate symptoms rather than improve them.
An example is turmeric , a natural spice widely touted as a remedy for hives. Despite these claims, curcumin (the ingredient that gives turmeric its yellow color) is known to cause contact dermatitis in some people, as well as chronic hives.
Other topical remedies, such as aloe vera gel , can relieve itching, but are unlikely to do more than a cold compress.
If you decide to use any supplements or traditional medications, be sure to inform your doctor and make sure they do not interact with any medications you may be taking. (St. John's wort, for example, can lower the level of antihistamines in the blood.)
Colloidal oatmeal bath
If the itchiness and swelling are driving you crazy, a refreshing bath may be the quickest remedy. It immediately constricts dilated blood vessels and attenuates overactive nerve signals. Another supplement that can help reduce localized inflammation is colloidal oatmeal.
While current research is far from conclusive, some small studies have shown that colloidal oatmeal (finely ground oatmeal suspended in liquid, gel, or cream) can reduce the severity of itching and soften sore skin. It is widely available as a bath additive and soothing lotion.
For added relief, store the colloidal oatmeal lotion in the refrigerator.
People often turn to mind-body therapy because they are aware of the role thoughts and emotions play in overall health and perceptions of well-being.
Stress does not cause hives, but it can make symptoms worse, especially if the condition is chronic.
Various practices can be helpful in relieving stress. They include:
- Meditation that teaches you to distract your thoughts from physical sensations.
- Deep breathing (pranayama), a meditative practice in which your focus is on rhythmic breathing exercises.
- Guided imagery in which you create relaxing mental images
- Progressive Muscle Relaxation (PMR), in which you mentally tense and relax your muscles one by one.
Frequently asked questions
Hives tend to appear as certain areas of red, raised, and very itchy skin that turns pale when pressed. In particular, they can also appear anywhere on the body and can move, disappear, and reappear in a relatively short period of time.
Hives are the result of an abnormal immune response that can be caused by a variety of factors , including:
- Food allergies
- Drug allergy (drugs)
- Environmental allergies (eg, pollen, pet dander, insect bites)
- Physical reactions to cold, heat, pressure, sunlight.
- The exercise
- Certain infections and medical conditions (eg, Hashimoto's thyroiditis, type 1 diabetes, chronic kidney disease)
In many cases, urticaria can be considered idiopathic or spontaneous, meaning that the condition may be due to intrinsic factors rather than extrinsic triggers.
Generally, the most effective first-line treatment for hives is an over-the-counter antihistamine that does not cause drowsiness, such as:
Antihistamines help suppress the histamine reaction that causes hives. A cold compress can also relieve itching. Ultimately, the best way to treat hives is to try to avoid the allergy trigger that could be causing the reaction.
Taking a cold bath or soaking a washcloth in a bowl of ice water to use as a compress can help relieve the itching and swelling common with hives. Loose-fit clothing made of lightweight cotton or viscose can also reduce discomfort. Try to avoid textured fabrics like denim, wool, and linen.
Hives are self-limited, which means that they go away on their own after a few hours or in a day or two, if not sooner. In the case of chronic hives, the illness can last six weeks or more. Chronic cases are believed to be associated with an autoimmune response .
Usually not. Although hives usually only affect the skin, if it is accompanied by shortness of breath, rapid heart rate, dizziness, or stomach cramps, this could be a sign of a more serious allergic reaction and you should seek immediate medical attention. In rare cases, hives can be a sign of an underlying infection or illness. If you think you have recurring hives, be sure to discuss this with your healthcare provider.