What is the Best Antihistamine for Hives?

Antihistamines are the best choice to treat hives.. Brand X Pictures/Stockbyte/Getty Images

What medicines should I take for hives?

Hives, or urticaria, are a common symptom that affects up to 20% of people at some point in their lives. There are numerous causes of urticaria, and in many cases, the cause is never determined.

If the cause of a person’s hives can’t be determined, and therefore the trigger can’t be avoided, then treating the hives is the next step.

The treatment of choice for hives is antihistamines, especially with the newer, low-sedating forms.

There are many choices, including prescription-only forms and over-the-counter types. The best antihistamine for hives, in my opinion, is Zyrtec (cetirizine). Cetirizine is now available in over-the-counter forms without a prescription, including in generic forms. Claritan, Alavert and generics of these drugs (loratadine) are reasonable antihistamines for the treatment of hives as well, although loratadine doesn’t work nearly as well as cetirizine, in my experience. Benadryl (diphenhydramine) works as well, although it needs to be taken multiple times a day, and causes significant sedation.

There are many prescription forms of antihistamines to treat hives as well. These include newer, less-sedating types such as Allegra and its generic forms (fexofenadine), Clarinex (desloratadine), and Xyzal (levocetirizine), which is very similar to Zyrtec. Commonly used older, sedating antihistamines used to treat hives include hydroxyzine and doxepin, which is an anti-depressant with strong antihistamine effects.

I find that I only need to use oral or injectable corticosteroids in a small percentage of people with hives. However, it is common for non-allergy specializing physicians to use these medications. Antihistamines usually do a good job of treating hives with fewer side effects than corticosteroids.

Learn more about urticaria.


Practice Parameters for Disease Management: Acute and Chronic Urticaria and Angioedema. Ann Allergy. 2000; 85: S525-44.

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