Hives medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Hives, or urticaria, is a skin condition that affects up to 20% of people at some point in their life. Women are twice as likely as men to develop hives. This skin reaction is typically thought to occur because of an allergic reaction, although there can be other causes. Most cases of hives will go away on their own within 24 hours but some can last for months and be part of a larger medical concern.

What are hives?

Hives are a frequent and usually minor skin ailment. Symptoms of hives include itchy, red, and elevated lesions (welts) on the skin that develops when the body’s mast cells release histamine. These bumps might be round or ring-shaped, and they’re known as wheals.

Hives are usually harmless and temporary. Acute hives usually resolve in a few hours but can last up to 6 weeks. Any rash that lasts over 6 weeks is considered to be chronic urticaria.

Although hives are usually associated with an allergic reaction, some common causes can trigger them including:

• Airborne allergens
• Bacterial infections such as strep throat and urinary tract infections
• Viral infections such as mononucleosis or hepatitis
• Insect stings
• Food allergy
• Allergies to materials like latex
• Medications
• Plants
• Emotional stress
• Changes in body temperature due to heat, cold, or exercise
• Tight clothes
• Autoimmune disorders
• Inflammation of the blood vessels
• Thyroid disease

Because there are so many potential triggers, many times the actual cause can not be determined.

How are hives diagnosed?

In certain cases the trigger is obvious. You eat foods such as shellfish or nuts and then break out within a short time. In many cases though, finding the exact cause of hives can be very difficult. Your doctor may have you keep a diary if you have regular breakouts. You would include the part of the body the hives appeared, how long it lasted, as well as what you ate, and your activities immediately before the breakout.

Your healthcare professional may also do allergy testing, which can include skin tests or blood tests to find out what you are allergic to or if an illness is the cause.

What are some treatment options for hives?

The best treatment for hives is to determine the triggers and avoid them. To treat the symptoms of hives, your healthcare provider may recommend:

• Antihistamines. The newer oral antihistamines have very few side effects and work well to relieve symptoms. Some of these include Claritin (loratadine), Allegra (fexofenadine), and Zyrtec (cetirizine). If these don’t relieve the symptoms, they may try prescription Clarinex (desloratadine), Semprex (acrivastine), or Vistaril (hydroxyzine pamoate).
• Leukotriene inhibitors. These can be used in place of or along with antihistamines. Examples include Singulair (montelukast) and Accolate (zafirlukast).
• Histamine (H-2) blockers. Although usually used to treat reflux, they can also help treat hives. These include Zantac (ranitidine), Pepcid (famotidine), and Tagamet (cimetidine).
• Corticosteroids. Oral corticosteroids, such as prednisone, can help reduce swelling, redness, and itching. These are typically used for short-term control of more severe symptoms such as difficulty breathing.
• Epinephrine. Severe allergic reactions and swelling can lead to a life-threatening condition called anaphylaxis. Epinephrine is the only treatment for anaphylaxis. Signs and symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of your lips, eyelids, and tongue. If prescribed, you should keep this on you at all times and if you have to use it, seek medical attention immediately.
• Monoclonal antibodies. Xolair (omalizumab) injections are used to treat chronic hives that haven’t responded to other treatments. This is usually given at a dermatologist’s office under the skin once a month.

What is the best medication for hives?

The best medication for you will depend on the specific type of hives, medical history, medications you are already taking that may potentially interact with hives medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication. The table below includes a list of the most prescribed and over-the-counter FDA-approved hives medications.

Best medications for hives

Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.

What are the most common side effects of hives medications?

As with all medications, those used to treat hives will have some side effects. They will depend on which class of medication is used.

• Antihistamines’ most common side effects include drowsiness, headache, and dry mouth.
• Corticosteroids can cause mood swings, increased appetite, weight gain, acne, and fluid retention. Some more serious long-term side effects can include increased blood pressure, increased blood sugar, glaucoma, and an increased risk of infections.
• Leukotriene inhibitors are generally well tolerated but can cause cold symptoms such as cough, runny nose, or sore throat. They also cause diarrhea, headache, fatigue, ear infection, and flu-like symptoms.
• Monoclonal antibodies such as Xolair have side effects such as headache, joint pain, upper respiratory infections, and skin reactions at the site of injection.
• Epinephrine, which acts as a stimulant, can cause an increased heart rate, anxiousness, nervousness, tremors, increase sweating, and headache.

What are some home remedies for hives?

Most hives will go away within a few hours on their own. These are a few ways to help relieve some of the discomforts until then:

• Take a cool bath.
• Use cool or cold compresses.
• Wear loose, lightweight clothing.
• Use an OTC anti-itch cream/lotion such as calamine
• Try not to scratch.
• Avoid triggers.

Frequently asked questions about hives

What is the fastest way to relieve hives?

Hives will usually only last a few hours but oral OTC antihistamines, as well as topical anti-itch or anesthetics, will help quickly relieve the symptoms until the hives go away.

What does a hive look like?

A hive is a raised, itchy wheal or bumps on the skin that has redness surrounding it. It can affect any part of the body.

What medications most commonly cause hives?

Antibiotics and pain relievers, such as ibuprofen, naproxen, and aspirin, are the most common medications to cause hives. It’s conceivable that people who’ve taken these drugs for years might suddenly develop hives.

How can my doctor tell I have hives?

Your doctor can tell you have hives by looking at your rash. However, if you keep having hives, your doctor may need to perform tests to discover why you are experiencing them.

Will my seasonal allergies make my hives worse?

The cause of hives is not usually known but is very rarely associated will pollen allergies.

Related resources for hives

• Hives and your skin. WedMD.com
• Chronic hives overview. MayoClinic.org
• Hives overview. American College of Allergy, Asthma, and Immunology
• Hives: What are hives? Healthline.com
• Hives: an overview. American Academy of Dermatology Association
• Home Remedies: Help with itchy hives. MayoClinic.org