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What to Do if Antihistamines Stop Working for a Hives Rash

But even if antihistamines are working at first, they may stop working for hives. That’s when you’ll likely need to try a different option.
“Although over-the-counter antihistamines can usually be enough to provide relief, the activity of hives can wax and wane, which means antihistamines may be more or less effective at different times,” says Dr. Weiler. “When it becomes less effective, there are other choices in stepping up treatment.”
Here are four options your doctor might recommend if your antihistamines stop working for you.
1. H2 Blockers
- cimetidine
- famotidine
- nizatidine
2. Corticosteroids
Oral corticosteroids (also called steroids or glucocorticoids) such as montelukast and prednisone could be the next step if antihistamines aren’t working, Dr. Camp says.
3. Biologics
A next step in treatment is to consider biologic medications, particularly when hives become frequent or intense, and don’t respond to antihistamines or corticosteroids, says Amiirah Aujnarain, MD, an allergist, immunologist, and pediatrician at Kindercare Pediatrics in East York, Ontario, Canada.
4. Lifestyle Changes
- With the help of your doctor, identify and avoid any food triggers that may prompt symptoms.
- Reduce exposure to airborne allergens, like pet dander or pollen.
- Use detergents and soaps without scents or dyes, which could irritate your skin.
- Avoid extreme temperature changes, which can prompt hives or worsen symptoms for some people.
- Do your best to manage stress, which doesn’t directly cause hives but can make them worse.
- Wear loose-fitting, lightweight clothing to avoid skin irritation.
These lifestyle changes can be helpful for reducing the frequency, duration, and intensity of hives. But they’re often used as an addition to medications, not as a replacement.
The Takeaway
- Over-the-counter (H1) antihistamines are nearly always the first line of treatment for a hives rash, since these meds can block histamine, a chemical in the body that prompts hives symptoms.
- Prescription antihistamines, corticosteroids, and biologic medications are the next steps when over-the-counter options aren’t working for you.
- Some lifestyle changes may help ease hives. But they’re often used along with medication rather than in place of it.
- If you’re getting more-frequent hives, and especially if they’re becoming worse and you’re not getting relief from over-the-counter antihistamines, talk with your doctor about other options that can help.