How Urticaria (Hives) Is Treated

Urticaria (hives) is a common skin condition that affects up to 20% of people at some point in their lives. While many hive eruptions go away on their own without treatment, others may require medications and self-care therapies. The choice of treatment is largely based on the underlying cause and may include over-the-counter antihistamines, corticosteroids, anti-inflammatory drugs, monoclonal antibodies, or even a simple cooling bath.

tips for treating hives
Illustration by Brianna Gilmartin, Verywell

Home Remedies

Most cases of acute urticaria are allergy-related. Chronic urticaria (hives lasting over six weeks or recurring over months or years) is believed to be caused by an autoimmune response. In both cases, the hives are caused by a substance or condition that the body reacts abnormally to.

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

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

urticaria on legs
Urticaria on legs.

DermNet / CC BY-NC-ND

Simply removing yourself from the trigger may be enough to provide relief. By and large, acute hives are self-limiting and usually resolve within hours or days without treatment.

If the hives are especially itchy, you can use a wet, cold compress to soothe the itch and reduce swelling. The simplest way to do this is to soak a washcloth in a bowl of ice water and apply it directly to the skin.

To further ease the discomfort, wear loose clothing either made of cotton or a smooth, lightweight synthetic like rayon. Avoid wool, linen, denim, or any textured fabric that can irritate the skin. You should also avoid getting overheated, as this can exacerbate symptoms. And, whatever you do, do not scratch.

Over-the-Counter Remedies

Antihistamines are the best, first-line treatment for hives. These drugs work by suppressing histamine, a chemical produced by the immune system that instigates the symptoms of allergy. For most types of urticaria, an over-the-counter (OTC) antihistamine may provide ample relief.

Unlike older generation antihistamines, the newer options are typically non-drowsy and may last for as long as 24 hours. They include:

Side effects tend to be mild and include dizziness, dry mouth, nausea, constipation, and cough.

Benadryl (diphenhydramine), an older antihistamine, is generally avoided during the daytime due to its sedating effect, but it may help you sleep if the itchiness is keeping you up at night.

Histamine H2-receptor antagonists, also known as H2 blockers, are another class of drug sometimes used in tandem with antihistamines. Commonly prescribed to treat heartburn, H2 blockers work by narrowing blood vessels in the skin and, by doing so, relieve redness and inflammation. They include such popular OTC brands as:

  • Tagamet (cimetidine)
  • Pepcid (famotidine)

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

Prescriptions

Certain chronic forms may require different medications, particularly if the trigger is physical rather than allergic.

OTC antihistamines may not be strong enough to treat all forms of urticaria.

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

Antihistamines

Clarinex (desloratadine) is an antihistamine similar to Claritin and Zyrtec, but it is only available by prescription.

If non-drowsy antihistamines fail to provide relief, your healthcare provider may prescribe Vistaril (hydroxyzine pamoate) to be taken at bedtime. It is a stronger antihistamine used to treat a wide range of skin reactions including chronic urticaria, contact dermatitis, and histamine-related itch (pruritis).

Hydroxyzine is sedating for most patients and can lead to falls and confusion in the elderly. Less common side effects can include headache, stomach upset, and blurred vision.

Corticosteroids

If antihistamines fail to provide relief even at higher doses or cause intolerable side effects, your healthcare provider may opt to treat you with corticosteroids to quickly bring down the swelling and itchiness.

Corticosteroids are able to dampen the immune system as a whole. So whether the cause is allergic or autoimmune (both of which are mediated by the immune system), these drugs can "dial down" the symptoms when other drugs can't.

Prednisone is most commonly prescribed for this and may be delivered either by injection or in pill form.

Corticosteroids should only be used for short-term treatment due to the risk of serious side effects, including osteoporosis, glaucoma, and diabetes.

Leukotriene Modifiers

Leukotriene modifiers work by stopping the effects of or decreasing the production of leukotrienes, substances that can trigger the narrowing of air passages and promotes inflammation.

By tempering the latter effect, leukotriene modifiers have been noted to be useful in some cases of urticaria although the FDA has not labeled this class of medications to be used for urticaria.

Montelukast is among the medications that have a black box warning on their label, due to potential neuropsychiatric side effects.

Singulair (montelukast) is the most commonly used leukotriene modifier that is used off-label in the treatment of urticaria.

Common side effects of leukotriene modifiers include a headache, nausea, vomiting, insomnia, and irritability.

Doxepin

Doxepin is a tricyclic antidepressant that also acts as a powerful antihistamine. When prescribed in a low dose, doxepin can be extremely effective in treating hives that are persistent and of unknown origin (referred to as chronic idiopathic urticaria).

Side effects include drowsiness, dry mouth, dehydration, headache, fatigue, dizziness, and mood changes.

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

Doxepin is marketed under various brand names including Silenor, Zonalon, and Prudoxin.

Xolair (Omalizumab)

Xolair (omalizumab) is an injectable drug originally prescribed for people with asthma who failed to respond to corticosteroids. More recently, it has been approved to treat chronic idiopathic urticaria if 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 certain types of urticaria and dermatitis. With that being said, scientists are not quite sure how Xolair works insofar as most chronic hives are not related to one particular IgE-mediated allergy.

Common side effects including injection site swelling and pain, cough, dizziness, fatigue, rapid heartbeat, and chest tightness.

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 Medicines (CAM)

While many complementary and alternative medicines (CAMs) have been proposed to treat acute and chronic urticaria, the evidence thus far remains weak. This is especially true with chronic urticaria, the condition of which we still don't fully understand.

In addition to potentially having no benefit, some complementary and alternative medicines can aggravate symptoms rather than improve them.

One such example is turmeric, a natural spice widely touted as a hives remedy. Despite these claims, curcumin (the ingredient that gives turmeric its yellow color) has been known to trigger contact dermatitis as well as chronic urticaria in some people.

Other topical remedies, such as aloe vera gel, may cool the itch but will unlikely do anything more than a cool compress would.

If you choose to use a supplement or traditional medicine of any sort, be sure to advise your healthcare provider and ensure that it doesn't interact with medications you may be taking. (St. John's Wort, for example, can reduce the concentration of antihistamines in your blood).

Colloidal Oatmeal Baths

If the itchiness and swelling are driving you mad, the fastest form of relief may be a cooling bath. It immediately reduces dilated blood vessels and tempers hyperactive nerve signals. One additive that may help further relieve localized inflammation is colloidal oatmeal.

While the current research is far from conclusive, some smaller studies have suggested that colloidal oatmeal—a finely milled oatmeal suspended in liquid, gel, or cream—can reduce the severity of itching while softening inflamed skin. It is widely available as a bath additive and a soothing lotion.

For added relief, store your colloidal oatmeal lotion in the refrigerator.

Mind-Body Therapies

People often to turn to mind-body therapies as they acknowledge the role thoughts and emotions play in overall health and perception of well-being.

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

Certain practices may be beneficial in alleviating stress. They include:

  • Meditation, which teaches you how to redirect your thoughts from physical sensations
  • Deep breathing (pranayama), a meditative practice in which your focus is centered on rhythmic breathing routines
  • Guided imagery, in which you create calming mental images
  • Progressive muscle relaxation (PMR), in which you mentally tense and release your muscles one by one

Frequently Asked Questions

  • What do hives look like?

    Hives tend to show up as defined areas of very itchy, raised, reddened skin that blanche white when pressed. Notably, they also 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
    • Medication (drug) allergies
    • Environmental allergies (i.e., pollen, pet dander, insect bites)
    • Physical reactions to cold, heat, pressure, sunlight
    • Stress
    • Exercise
    • Certain infections and diseases (i.e., Hashimoto's thyroiditis, type 1 diabetes, chronic kidney disease)

    In many cases, hives may be considered idiopathic or spontaneous, meaning the condition may arise due to internal factors rather than external triggers.

  • How can I treat hives at home?

    Generally, the most effective, first-line treatment for hives is an over-the-counter (OTC) non-drowsy antihistamine, such as:

    Antihistamine drugs help quell the histamine response that causes hives to form. Using a cold compress can also be helpful to reduce itching. Ultimately, the best way to treat hives is to try and avoid the allergy trigger that might be at the root of the reaction.

  • How can I relieve symptoms of hives?

    Taking a cool bath or soaking a washcloth in a bowl of ice water to use as a compress can be helpful in relieving the itching and swelling that's common with hives. Wearing loose cotton or lightweight rayon clothing may also help reduce discomfort. Try to avoid textured fabrics, like denim, wool, and linen.

  • How long do hives typically last?

    Hives are self-limiting, which means they will resolve on their own after a few hours or within a day or two, if not sooner. In cases of chronic hives, the condition may last for six weeks or longer. Chronic cases are considered to be related to an autoimmune response.

  • Are hives a sign of something more serious?

    Usually not. While hives generally only affect the skin, if they are accompanied by trouble breathing, rapid heart rate, dizziness, or stomach cramps, this could be a sign of a more serious allergic reaction, and you should seek immediate medical treatment. Rarely, hives can be a sign of an underlying infection or disease. If you seem to get recurring hives, be sure to explore this with your healthcare provider.

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Article Sources
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