Best Medications for Hives

Newer antihistamines work longer and some are available over-the-counter

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

Hives, or urticaria, is a common skin condition that affects up to 20 percent of people at some point in their lives. Hives are typically raised, red and itchy, and can be of various shapes and sizes. The rash will tend to come and go within a few hours, moving from one place on the body to another.

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.

What Are the Best Medications to Treat Hives?

The best treatment for hives is with an antihistamine. Antihistamines are usually given in pill or liquid form, and may need to be given in large or frequent doses to control the symptoms. 

Older antihistamines, also called first-generation antihistamines, such as Benadryl (diphenhydramine), Vistaril (hydroxyzine), or ChlorTrimeton (chlorpheniramine), are considered to be too sedating for the routine treatment of urticaria.

In addition, first-generation antihistamines need to be taken multiple times a day, as their antihistamine effects are very short acting. Newer antihistamines, also called second-generation antihistamines, such as Claritin (loratadine), Allegra (fexofenadine) and Zyrtec (cetirizine), are better choices for the treatment of hives.

They are less sedating and generally work for 24 hours, so they only require once-a-day dosing.

Most newer antihistamines, with the exception of Clarinex (desloratadine) and Xyzal (levocetirizine), are available over-the-counter without a prescription.

Other Medication Options

If none of the second-generation antihistamines relieve your symptoms, there are other medical options that may be added on to 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.

A medication called Singulair (montelukast), sometimes used in asthma treatment, may also be tried if a person does not get relief with a second-generation antihistamine. 

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. 

Finally, a medication called Xolair (omalizumab) may be considered, which is given by injection in a doctor's office.

Behavioral Treatments for Hives

In addition to medication, behavioral measures are also important in managing and worsening your hives. Examples of healthy habits include:

  • wearing loose-fitting, cotton clothing
  • using hypoallergenic soaps and skin-care products
  • avoiding scratching as much as possible
  • using cool compresses for instant relief when needed

    If the cause of the urticaria is known or suspected, such as a food or medicine, avoidance of the trigger may resolve the symptoms.

    A Word From Verywell

    In most cases, the symptoms of hives only last a few days, and often the cause is never known. If the symptoms of hives last for many weeks or a couple of months,  consult an allergist should for appropriate testing and treatment.

    Sources:

    American College of Allergy, (2014). Asthma and Immunology. Hives (urticaria). 

    Bernstein JA et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7.

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