Best Antihistamines for Hives

Over-the-Counter, Prescription, and Complementary Treatments

Package of antihistamines
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Hives (urticaria) is a common skin condition that will affect up to 20 percent of people at some point in their lives. Hives are raised, red, and itchy welts of various shapes and sizes. The rash can come and go within hours, often moving from one part of the body to another.

There are numerous causes of urticaria, although, in many cases, the cause may never be found.

If the cause cannot be determined, the next step would be to identify the drugs able to treat the symptoms with minimal side effects.

Antihistamines

The best, first-line treatment for hives are antihistamines. They work by suppressing histamine, a chemical produced by the immune system that triggers the symptoms of allergy. Antihistamines are usually given in pill or liquid form.

Among the options:

  • Older, first-generation antihistamines, such as Benadryl (diphenhydramine), Vistaril (hydroxyzine), or Chlor-Trimeton (chlorpheniramine), are usually avoided because they are too sedating. They are also short-acting and need to be taken several times a day.
  • Newer, second-generation antihistamines, such as Claritin (loratadine), Allegra (fexofenadine) and Zyrtec (cetirizine), are far better choices, providing long-lasting relief with minimal drowsiness. Most of the newer antihistamines, with the exception of Clarinex (desloratadine) and Xyzal (levocetirizine), are available without a prescription.

    With that being said, Benedryl is sometimes prescribed at night because it can help a person sleep if the hives are particularly itchy or uncomfortable.

    Other Drug Options

    If antihistamines are unable to provide relief, additional or substitute medications may be prescribed. This is especially true with chronic hives which are inherently hard to treat.

    Among the options:

    • Histamine (H2) blockers can be used in conjunction with antihistamines. Commonly prescribed to treat heartburn, H2 blockers work by narrowing blood vessels in the skin and, by doing so, relieve redness and inflammation. Options include Tagamet (cimetidine), Zantac (ranitidine), and Pepcid (famotidine). Oral and injected formulations are available.
    • Singulair (montelukast), an oral drug commonly used in asthma therapy, may be useful in treating cholinergic urticaria caused by excessive heat or exercise.
    • Corticosteroids may be used if the hives do not respond to other treatments. These anti-inflammatory drugs are usually taken in pill form but may be injected in severe cases. They work by dampening the immune response and can only be used for short periods due to the risk of side effects.
    • Xolair (omalizumab) is an injectable drug used in cases where the hives are persistent and unknown (referred to as chronic idiopathic urticaria).

    A Word From Verywell

    In addition to medications, there are things you can do to manage and relieve the symptoms of urticaria. Among them:

    • Wear loose-fitting, cotton clothing if ever you experience an outbreak.
    • Use hypoallergenic soaps and skincare products.
    • Avoid scratching the hives as much as possible.
    • Use cool compresses to help relieve itching and inflammation.
    • Avoid getting overheated as this can exacerbate the symptoms.

    In most cases, the hives will last for only a few days. If they persist or worsen, see your doctor or contact an allergist for appropriate testing and treatment.

    On the other hand, if hives are accompanied by symptoms of anaphylaxis (wheezing, blistering, rapid heart rate, or the swelling of the face, hands, feet, throat, or tongue), call 911 or seek emergency care.

    Sources:

    Bernstein, J.; Lang, D.; Khan, D.; et al. "The diagnosis and management of acute and chronic urticaria: 2014 update. " J Allergy Clin Immunol. 2014; 133(5):1270-7. DOI: 10.1016/j.jaci.2014.02.036.