What Is the Best Antihistamine for Hives?

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

Hives, or urticaria, are a common dermatologic condition that affects up to 20 percent 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. Sometimes, treating hives can be a trial-and-error process and zeroing in on the best treatment takes some time.

To start, wear loose-fitting, cotton clothing and use hypoallergenic soaps and skin-care products to avoid further irritation. In addition, try to avoid scratching as much as possible and use cool compresses for instant relief when needed.

Antihistamine Options

Most physicians recommend antihistamines. It may take days or even weeks for treatment with antihistamines to help, and a once-a-day dosing schedule helps block histamine release on an ongoing basis so symptoms begin to die down.

Because you may need to take an antihistamine once a day, it is often best to start with one of the newer (second-generation) antihistamines. These tend to have fewer side effects, such as drowsiness, compared with the older antihistamines.There are many choices, including prescription-only forms and over-the-counter types. The best antihistamine for hives, in my opinion, is Zyrtec (cetirizine). Zyrtec is now available in over-the-counter forms without a prescription, including in generic forms.

 Claritin (loratadine), Allegra (fexofenadine), Xyzal (levocetirizine), and Clarinex (desloratadine) all are reasonable antihistamines for the treatment of hives as well, although Claritin doesn’t work nearly as well as Zyrtec, in my experience.

If the second-generation antihistamines don't work to reduce your symptoms, your physician may recommend taking an older one.

However, because these first-generation antihistamines can cause significant drowsiness, you may need to take them at bedtime. First-generation antihistamines include Vistaril (hydroxyzine), Benadryl (diphenhydramine), and Chlor-Trimeton (chlorpheniramine). 

Other Options

If none of the antihistamines relieve your symptoms, there are other medical options that may help. These include histamine (H-2) blockers (also called H-2 receptor antagonists). These medications, including Tagamet (cimetidine), Zantac (ranitidine), Axid (nizatidine), and Pepcid (famotidine) are best known for treating acid indigestion but have shown some success in treating hives as well. They may be either injected or taken orally.

In addition, anti-inflammatory medications such as corticosteroids may be used when hives have not responded to other treatments. These medications are usually taken orally for a short time to reduce the risk of side 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. 

Source

Hives (urticaria). American College of Allergy, Asthma and Immunology. 

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