Best Treatment for Hives

Urticaria rash (hives) on legs due to exam stress Creative RM By:
Dr. P. Marazzi/Science Photo Library/Getty Images

Urticaria, commonly known as hives, is a disorder affecting up to 20% of the population at some point in their lives. The swelling that sometimes accompanies hives, called "angioedema," can lead to swelling of the face, hands, and feet. Hives usually feel very itchy and burning (although angioedema is often painful) or cause a tingling sensation — and these symptoms often make people miserable.

While people who suffer from hives are not alone, this isn’t much of a comfort to them when their lives are consumed with not knowing why they have their symptoms.

Hives can literally turn a person’s life upside down: They’re uncomfortable. One often doesn’t know what’s causing their hives, why they can’t sleep and why they don’t want to leave their homes or go to work — all of this can lead to emotional distress. Yet, hives are often easily treated with medications.

In my allergy clinic, I see people every day who suffer from hives. Some people have had symptoms for a few days; others have had symptoms for decades, and yet, each and every one of them is extremely bothered by their symptoms. Through a proper evaluation and treatment plan, almost all people who suffer from hives can achieve good control of their symptoms, but may not be able to be cured.

Learn more about the basics of hives.

What Causes Hives?

Just about every patient I see has some suspicion of what could be causing their hives. Most are concerned with some type of food allergy, some think that a medication or environmental trigger (such as an odor or chemical) is the cause, while others are concerned with a physical trigger, such as heat or cold.

While any of the above triggers are possible, the most common cause of acute hives (those lasting less than 6 weeks) are viral infections (such as the common cold), and the most common cause of chronic hives (those lasting greater than 6 weeks) are autoimmune causes.

In addition, stress can cause hives, whether or not the stress is good stress (going on vacation) or bad stress (death in the family).

Learn more about what causes hives.

Physical Hives

Physical causes for hives occur in up to 20% of people with chronic hives. These physical triggers include pressure (called "dermatographism"), heat (called "cholinergic"), cold, sunlight (solar urticaria) and exercise (exercise-induced anaphylaxis). Each one of these forms of physical hives has unique features that warrant special consideration.

Learn more about each form of physical hives:

Treatment of Hives

Most often, a cause of hives cannot be found. In these cases, medications are used to control symptoms. Antihistamines, taken by mouth, are the medications of choice for the treatment and prevention of hives. Corticosteroids are often given to people with hives as well, but caution should be used if these medications are to be used long term, given the side effects of corticosteroids.

Xolair, approved for the treatment of chronic hives in March 2014, is a monoclonal antibody against IgE that can significantly reduce the amount of hives a person experiences. 

Learn about the best ways to treat hives.


Casale TB. Omalizumab for Chronic Urticaria. J Allergy Clin Immunol Pract. 2014;1:118-9.

Kahn DA. Alternative Agents in Refractory Chronic Urticaria: Evidence and Considerations on their Selection and Use. J Allergy Clin Immunol Pract. 2013;1:443-40.

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