Hives Treatment Overview

When to see a healthcare provider

See a healthcare provider if hives don’t go away after about 2 days or don’t improve after taking antihistamines. Also call your provider if you get hives after taking medication. Your provider may refer you to a dermatologist or an allergist for allergy testing.

It’s important to see a provider for chronic hives. They may be a sign of an underlying health condition like diabetes or rheumatoid arthritis.

Getting diagnosed

• Your healthcare provider can diagnose hives based on your medical history and symptoms.
• If an allergy is suspected, you may be referred to an allergist for allergy testing. Typically they will do skin testing, where you are pricked with needles containing small amounts of different allergens to see if anything triggers a skin reaction.
• Blood tests are occasionally used to check for underlying causes of hives.
• Your doctor may also take a small sample of skin from the affected area (skin biopsy) to help with the diagnosis.

What to expect from your doctor visit

• Your provider will help determine what is causing your hives, either through your medical history or allergy testing.
• If a medication triggered the hives, your provider will likely switch you to a different medication.
• To treat the hives, your provider may recommend trying different types of OTC antihistamines.
• If OTC antihistamines don’t help, prescription antihistamines may be given.
• Leukotriene receptor antagonists, like montelukast (Singulair) and zafirlukast (Accolate), can help treat certain cases of hives.
• A short course (about 1 week) of steroids like prednisone or methylprednisolone (Medrol) may be prescribed for hives that don't go away or if you have significant swelling with the hives.
• Light therapy, also called phototherapy, may be recommended if other treatments don’t work.
• Immunomodulatory therapies may be recommended by allergy and immunology specialists in severe cases that do not improve with other treatments.

Prescription medications for hives

• Prescription antihistamines: hydroxyzine (Atarax, Vistaril), acrivastine (Semprex), desloratadine (Clarinex), promethazine (Phenergan)
• Leukotriene receptor antagonists: montelukast (Singulair), zafirlukast (Accolate)
• Immunomodulatory therapies: omalizumab (Xolair), cyclosporine, tacrolimus
• Oral steroids: prednisone, methylprednisolone (Medrol)

Types of hives providers

• A primary care provider can treat mild to moderate symptoms.
• If your hives are severe, you may be referred to a dermatologist, who specializes in treating the skin.
• Hives caused by allergies may be treated by an allergist or immunologist.

Treating hives at home

Occasional hives can usually be treated at home. Symptoms can be treated with OTC antihistamines and lifestyle changes.

OTC medications

• Newer, second generation antihistamines: fexofenadine (Allegra), cetirizine (Zyrtec), loratadine (Claritin)
• Older, first generation antihistamines: diphenhydramine (Benadryl),  chlorpheniramine (Chlor-Trimeton). These can make you sleepy and are best taken at bedtime.
• H2-blocking antihistamines: famotidine (Pepcid), ranitidine (Zantac)

Tips for relieving itchiness of hives

• Wear light, loose-fitting clothing.
• Take soothing cool showers. You can also place a cool cloth on your hives.
• Avoid scratching your skin.
• Use mild, unscented soaps.

Wellness and prevention

• Avoid known triggers. Common triggers of hives include animal saliva and dander, sunlight, insect bites and stings, certain foods and medications, and extreme hot or cold temperatures.