How Urticaria (Hives) Is Treated

Acute urticaria (hives) is a common skin condition that affects up to 20% of people at some point in their lives, and can transition into chronic urticaria for up to 8% of the population. Hives tend to go away on their own without treatment, but self-care strategies like taking a cooling bath can help manage discomfort.

Some people, however, may require medication such as an antihistamine, anti-inflammatory drug, corticosteroid, or monoclonal antibodies. The choice of treatment for hives is based largely on the underlying cause.

This article offers a detailed overview of the options, including home remedies, over-the-counter medications, prescription drugs, and complementary and alternative therapies.

tips for treating hives

Verywell / Brianna Gilmartin

Types of Urticaria

Urticaria is usually classified as acute or chronic. The major difference depends on how long the symptoms last.

Acute

Acute cases of urticaria are those that come on suddenly and are short-lived. Most are allergy-related. The skin comes in contact with a normally harmless substance that the immune system mistakes as something it needs to eliminate, which triggers the skin reaction.

The reaction may be triggered by any number of things, including foods, drugs, pollen, insect bites, and latex. Even certain physical triggers—such as heat, cold, pressure, sun, exercise, and vibration—can set off an immune response that leads to hives.

Chronic

Hives are considered chronic if they last for more than six weeks. They're thought to be caused by an autoimmune response, not an allergic one. Autoimmune means that the immune system is attacking healthy cells in the body as if they were invaders. This may be due to an autoimmune disease or an unknown cause.

Autoimmune hives may improve by treating the underlying cause. For example, chronic urticaria is sometimes related to autoimmune thyroid disease. There is evidence that treating the thyroid condition may also improve urticaria symptoms. 

If your urticaria is related to an autoimmune condition, you can still use many of the same treatments that are typically used for allergic skin reactions.

Home Remedies

When you have acute urticaria caused by an allergic reaction, it is important to find out what your triggers are. Taking steps to avoid your triggers is the best thing you can do on your own to treat acute hives.

If your hives are caused by an autoimmune response, you won't have any triggers to avoid. But the following tips for treating itchiness and swelling due to hives can still help, no matter the cause:

  • Apply a wet, cold compress: The simplest way to do this is to soak a washcloth in a bowl of ice water and apply it directly to the skin. A cooling bath can also help.
  • Wear loose clothing: This type of clothing allows for airflow and to reduce friction on the skin.
  • Choose fabrics wisely: Opt for articles made of cotton or a smooth, lightweight synthetic like rayon. Avoid wool, linen, denim, or any textured fabric that can irritate the skin.
  • Stay cool: Avoid getting overheated by dressing in layers that you can remove, if needed, choosing to shower in cool water, and staying in air conditioning when it's hot outside.
  • Do not scratch: It's more than tempting, but scratching your skin can make your hives worse.

Recap

You can reduce the itching and discomfort of hives by applying a cool, moist towel to the skin or taking a cooling bath. Wear lightweight clothing during the day and avoid scratching.

Over-the-Counter Remedies

Most cases of acute urticaria can be treated with OTC drugs that dampen the allergic response. This mainly involves antihistamines, but can also include a class of drugs called H2 blockers.

Antihistamines

Antihistamines are the best, first-line treatment for hives, both acute and chronic. They work by suppressing histamine, a chemical produced by the immune system that triggers allergy symptoms.

Newer antihistamines are non-drowsy and their effects may last for as long as 24 hours. These drugs include:

Benadryl (diphenhydramine), an older antihistamine, is generally avoided during the daytime as it can cause drowsiness, but it may help you sleep if itching is keeping you up at night.

H2 Blockers

Histamine H2-receptor antagonists, also known as H2 blockers, are another class of drug sometimes used with antihistamines.

Commonly used to treat heartburn, H2 blockers work by narrowing blood vessels in the skin. This helps relieve redness and swelling. H2 blockers may be used to help control both acute and chronic hives.

This photo contains content that some people may find graphic or disturbing.

urticaria on legs
Urticaria on legs.

DermNet / CC BY-NC-ND

Popular OTC H2 blockers include:

  • Tagamet (cimetidine)
  • Pepcid (famotidine)

Side effects include a headache, dizziness, diarrhea, muscle ache, joint pain, and rash.

Recap

OTC antihistamines like Claritin and Allegra are the first-line options for treating acute and chronic urticaria. More severe hives may benefit from adding an H2 blocker like Tagamet or Pepcid.

Prescriptions

OTC antihistamines may not be strong enough to treat all forms of urticaria. Certain chronic forms may require different medications, particularly if the trigger is physical rather than allergic.

Among the prescription drugs commonly used are antihistamines, corticosteroids, leukotriene modifiers, and a monoclonal antibody specifically approved to treat chronic urticaria.

Antihistamines

Prescription antihistamines may be used to treat both acute and chronic hives.

Clarinex (desloratadine) is an antihistamine similar to Claritin and Zyrtec, but it is only available by prescription. It is less likely to cause drowsiness compared to other older antihistamines.

If non-drowsy antihistamines fail to provide relief, your doctor may prescribe Vistaril (hydroxyzine pamoate) to be taken at bedtime.

Vistaril is a stronger antihistamine used to treat a wide range of skin reactions, including chronic urticaria and contact dermatitis. Common side effects can include headaches, stomach upset, and blurred vision.

Corticosteroids

If prescription antihistamines fail to provide relief or cause intolerable side effects, your healthcare provider may prescribe corticosteroids (steroids) to quickly bring down the swelling and itchiness.

Corticosteroids work by suppressing the immune system as a whole. By "dialing down" the response, corticosteroids can relieve hives caused by either an allergic or autoimmune reaction.

Prednisone is the most commonly prescribed option, delivered either by injection or pill.

Corticosteroids may be used for both acute and chronic hives, but they are intended for short-term use only. If you have chronic hives, your healthcare provider may prescribe corticosteroids for the short-term treatment of flare-ups. The long-term use of prednisone is linked to an increased risk of osteoporosis, glaucoma, and diabetes.

Leukotriene Modifiers

Leukotriene modifiers work by blocking the effects of or production of leukotrienes, These are substances that can trigger the narrowing of air passages and promote inflammation, among other things. Your healthcare provider may prescribe these if you have chronic hives and antihistamines are not helping.

Singulair (montelukast) is the most common leukotriene modifier prescribed for hives. Accolate (zafirlukast) is sometimes also used to treat hives.


By tempering inflammation, leukotriene modifiers may be useful in treating certain treatment-resistant forms of urticaria. However, use is considered off-label, as the U.S. Food and Drug Administration (FDA) has not approved these drugs for this purpose.

Doxepin

Doxepin is a tricyclic antidepressant that also acts as a powerful antihistamine. It's marketed under various brand names including Silenor, Zonalon, and Prudoxin. When prescribed in a low dose, doxepin can be extremely effective in treating chronic or idiopathic (of unknown origin) hives.

Doxepin must be used under medical supervision as it can cause suicidal thoughts in children and young adults with a history of depression or mental illness.

Anti-Inflammatory Antibiotics

These include the prescription drugs Aczone (dapsone) and Azulfidine (sulfasalazine). These drugs don't work for everyone, but your healthcare provider might decide to prescribe them if you aren't responding well to first-line treatment.

Neoral (cyclosporine)

Neoral is a calcineurin inhibitor. It is typically used to prevent organ transplant rejection and is sometimes also used for psoriasis and rheumatoid arthritis.

Cyclosporine can effectively treat severe cases of chronic urticaria. It should not be used long-term because it may cause serious side effects.

Procardia (nifedipine)

Procardia is a calcium channel blocker typically used to treat high blood pressure. For some people, it may be effective as a second-line treatment for urticaria.

Mitigare (colchicine)

Mitigare (colchicine) is sometimes prescribed to treat gout, but it may also work against urticaria. It is typically used for patients who don't respond to first-line antihistamine treatment.

Xolair (Omalizumab)

Xolair (omalizumab) is an injectable drug originally prescribed for people with asthma. It has also been approved to treat chronic idiopathic urticaria if all other treatments fail.

Xolair is a monoclonal antibody that works by blocking a protein that instigates an allergic response. Even so, scientists are not exactly sure how Xolair works insofar as most chronic hives are not allergy-related.

Recap

If over-the-counter drugs are unable to relieve hive symptoms, prescription drug options include antihistamines like Clarinex or Vistaril, Singulair (a leukotriene modifier), doxepin (a tricyclic antidepressant), or Xolair (a monoclonal antibody).

Hives Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Man

Complementary and Alternative Medicines

While many complementary and alternative medicines are used to treat acute and chronic hives, the evidence supporting their use remains weak. Not only may some have no effect, but a few may also end up aggravating symptoms.

One such example is turmeric, a spice widely touted as a hives remedy. Studies have shown that curcumin, the substance that gives turmeric its yellow color, can trigger skin irritation and hives in some people.

If you choose to use a natural remedy, speak with your doctor first to ensure that it doesn't interact with any medications you may be taking.

Colloidal Oatmeal

If the itching and swelling are driving you mad, the fastest form of relief may be a cooling bath. It helps reduce swelling and tempers hyperactive nerve signals that trigger itchiness.

One additive that may help further relieve symptoms is colloidal oatmeal.

Some smaller studies have suggested that colloidal oatmeal—a finely milled oatmeal suspended in liquid, gel, or cream—can reduce the intensity of itching while softening inflamed skin.

It is widely available as a bath additive and is an ingredient in some soothing lotions. For added relief, store your colloidal oatmeal lotion in the refrigerator.

Mind-Body Therapies

Stress does not cause urticaria but can aggravate the symptoms, particularly when the condition is chronic.

People often turn to mind-body therapies to relieve stress and the many health problems stress and anxiety can cause.

These include practices such as:

  • Meditation
  • Deep breathing exercises
  • Guided imagery: A relaxation technique involving the conjuring of mental images that can help you "escape"
  • Progressive muscle relaxation (PMR): A methodical tensing and relaxing of all of your major muscle groups
  • Biofeedback: A provider uses information from instruments that monitor your body's functions to advise you as to how to alter them on your own

Recap

There are few complementary or alternative therapies that have proven effective in treating hives. Two possible options are colloidal oatmeal which may help reduce inflammation and itching and mind-body therapies to reduce the stress associated with chronic outbreaks.

Summary

There are many possible ways to treat urticaria (hives) depending on the underlying cause. These include home remedies like a cold compress or over-the-counter drugs like antihistamines and H2 blockers.

Chronic or treatment-resistant hives may benefit from prescription antihistamines as well as approved and off-label drugs like Xolair (omalizumab), doxepin, or Singulair (montelukast).

Complementary therapies may also help, including colloidal oatmeal baths or mind-body practices like meditation that can reduce the stress that makes chronic hives worse.

Frequently Asked Questions

  • What do hives look like?

    Hives tend to be well-defined areas of itchy, raised, and reddened skin that turn white when pressed. They can appear anywhere on the body and may move around, disappear, and reappear in a relatively short period of time.

  • What causes hives?

    Hives are the result of an abnormal immune response that can be caused by a wide variety of factors, including:

    • Food allergies
    • Drug allergies
    • Pollen
    • Insects bites
    • Exercise
    • Stress
    • Exposure to cold, heat, pressure, or vibration
    • Certain infections and diseases
  • How can I treat hives at home?

    Generally, the most effective, first-line treatment for hives is an over-the-counter, non-drowsy antihistamine like Allegra (fexofenadine) or Claritin (loratadine).

  • How can I relieve the symptoms of hives?

    Take a cool bath or apply a cold, wet washcloth to your skin to relieve itching and swelling. Wear loose, breathable clothing, avoid textured or irritating fabrics, and do not scratch hives.

  • How long do hives typically last?

    Acute hives associated with allergies will usually resolve on their own within a few hours or days. Chronic hives associated with autoimmunity can last six weeks or longer in some cases.

  • Are hives a sign of something more serious?

    Usually not. With that said, if hives are accompanied by trouble breathing, rapid heart rate, vomiting, or the swelling of the face or throat, this could be a sign of a serious allergic reaction known as anaphylaxis. Seek emergency care.

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