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Finding the Right Treatment for Hives

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Treatment Advances for Relieving Hives

Medically Reviewed By William C. Lloyd III, MD, FACS

Hives, also called urticaria, break out when your body tries to fight a threat by releasing histamines. The release prompts the itchy red welts that range from mild to maddening and last for hours or months. The standard treatment is antihistamine medication. It works well for many people, especially if the hives are short-term, or acute. Most cases of acute hives clear up within 24 hours. For those with chronic hives, which last for six weeks or more, standard treatment may not be enough. Learn about treatment advances that put more alternatives for hives relief within reach.

What Causes Hives?

Different types of hives are caused by different types of triggers or an unknown trigger.

  • Acute urticaria is usually caused by an infection, an insect sting, or a reaction to food or medication.

  • Chronic physical (inducible) urticaria is usually caused by something in your physical environment that can be changed, such as tight clothing or exposure to extreme temperature.

  • Chronic idiopathic (spontaneous) urticaria, or CIU, is caused by something that can’t be identified.

When the trigger can be identified and eliminated, hives symptoms usually clear up relatively quickly. Unfortunately, 95% of chronic hives are of the CIU type. Since the cause can’t be pinpointed, more time may be needed to determine the best treatment for you.

Hives Relief With Antihistamines

If your itching and discomfort is mild, you may not need medication. If it’s severe, your doctor will likely prescribe a “non-sedating” antihistamine that doesn’t cause drowsiness. If it doesn’t relieve hives, a sedating medication taken at night may be recommended. Antihistamines are given for both acute and chronic hives, and a corticosteroid may also be added for a short period of time to totally clear your hives and “start over” with a clean slate for treatment.

For up to 50% of those with CIU, however, hives persist despite antihistamine treatment. While the exact cause of ICU can’t be pinpointed, it has to do with the immune system becoming overactive when it doesn’t need to, and attacking healthy cells. Because of this activity, CIU is considered an autoimmune condition. Some people with CIU have other autoimmune conditions that cause swollen joints or thyroid problems. 

New Alternatives for Relieving Hives

When your hives won’t go away, it’s normal to feel a little helpless—and hopeless. But major treatment advances have been made over the last decade, bringing more treatments that are bringing relief to more people around the globe.

These medications include:

  • Anti-inflammatory antibiotics such as dapsone (Aczone) and sulfasalazine (Azulfidine)

  • Tricyclic antidepressants such as doxepin (Silenor, Zonalon) that happen to have antihistamine effects

  • Cyclosporin (Neoral, Sandimmune) and other immunosuppressive drugs that decrease the overactive immune response

  • Omalizumab (Xolair), an injected biologic medication that works with the body’s immune system at the cellular level to stop faulty signals that cause symptoms

Additional treatments are being tested in clinical trials. For example, hydroxychloroquine, a medication originally used to treat malaria, was shown to improve or completely clear hives for 83% of the people who took it. When it comes to finding the effective treatment you deserve, don’t give up easily. Keep the conversation going with your doctor about treatment steps, timeframes, what to try when, and what’s new.

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  1. Hives/Urticaria. Columbia University Irving Medical Center.
  2. Hives: Diagnosis and Treatment. American Academy of
    Dermatology Association.
  3. Hives and
    diagnosis and treatment. Mayo Clinic.
  4. Urticaria. American Osteopathic College of Dermatology.
  5. JAMA Dermatology. Successful
    Treatment of Recalcitrant Chronic Idiopathic Urticaria With Sulfasalazine.
  6. The Expanding Field of Biologics in the Management of
    Chronic Urticaria. US National Library of Medicine National
    Institutes of Health.
  7. Chronic
    Urticaria Treatment and Management. Medscape.
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 4
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