Symptoms, Causes, Diagnosis, Treatment, and Prevention

How you treat hives depends on how many you’ve had and how long they’ve been active.

Medication

Medications for hives include antihistamines, steroids, epinephrine, and monoclonal antibodies.

Over-the-Counter Antihistamines

• diphenhydramine (Benadryl)
• loratadine (Claritin)
• fexofenadine (Allegra)
• cetirizine (Zyrtec)
• levocetirizine (Xyzal)

If you have one patch of hives that goes away within 24 hours and no associated breathing issues, you probably don’t need medical attention. Instead, you might take an OTC nonsedating antihistamine to ward off a second hive outbreak, Friedman says. “It’s more about prevention or active treatment,” he says.

Epinephrine

If you notice hives and breathing difficulties, head to the emergency room or seek other urgent care. Medical professionals will most likely inject you with epinephrine. This drug opens the airways in your lungs.

Corticosteroids

Monoclonal Antibodies

These injectable prescription medications can help reduce the immune overactivity that causes allergy symptoms and soothe itching over time when other medications have not been effective.

• dupilumab (Dupixent)
• omalizumab (Xolair)

Researchers are studying other monoclonal antibody drugs for treating hives.

Off-Label and Emerging Medications

Off-label drugs are those that the U.S. Food and Drug Administration (FDA) has approved for treating conditions other than hives. However, doctors may prescribe them if chronic hives don’t respond to approved treatments.

• cyclosporine (Neoral, Sandimmune)
• methotrexate (Rheumatrex, Trexall)
• azathioprine (Imuran)
• mycophenolate mofetil (CellCept)
• dapsone
• hydroxychloroquine (Plaquenil)
• TNFα inhibitors (Enbrel, Humira)

Elmariah is enthusiastic about progress toward new treatments that reduce the sensitivity of mast cells to various triggers,  preventing the release of histamine in the first place. “Other medications, including a pill option known as remibrutinib, are far along in development, have demonstrated tremendous benefit for patients with hives, and may get FDA approval soon,” she says.

Phototherapy

Phototherapy, or light therapy, involves exposing the skin to a controlled dose of ultraviolet light. A doctor may recommend it for treating hives that don’t respond to antihistamines.

Managing Hives in Children

• cetirizine, either in liquid or tablet form
• diphenhydramine liquid, capsules, or tablets, although these can cause drowsiness
• fexofenadine tablets
• loratadine tablets