Mayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Treatments and drugs
By Mayo Clinic staffFinding an effective treatment for chronic hives can be challenging. In cases in which a trigger is identified — such as a reaction to a certain food, medication or physical stimulus — treatment includes avoiding the trigger. If your chronic hives are caused by an underlying health condition, they may improve when the underlying condition is treated.
Symptoms can be treated effectively in most people with over-the-counter or prescription medications. Work with your doctor to find the medication — or combination of medications — that works best for you. If the first medication you try doesn't relieve your symptoms, talk to your doctor about trying something else.
Oral antihistamines
These medications block the symptom-producing release of histamine, controlling symptoms for the majority of people with chronic hives — but they do not treat the underlying cause of the rash. You may need to take antihistamines every day. Some of these medications are available over-the-counter, whereas others require a prescription. A combination of antihistamines may work best.
Your doctor may have you start with newer, nonsedating or low-sedating antihistamines, such as:
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Desloratadine (Clarinex)
Check with your doctor before taking any of these medications if you're pregnant, have a chronic medical condition or are taking any other medications.
If a nonsedating antihistamine doesn't work, your doctor may recommend taking a different type of antihistamine. These antihistamines, which can make you drowsy, include:
- Hydroxyzine (Vistaril)
- Diphenhydramine (Benadryl, others)
- Chlorpheniramine (Chlor-Trimeton)
Other medications
If antihistamines alone don't relieve your symptoms, other possible treatments include:
- H2 antagonists. These medications, such as cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid AC), can be used along with antihistamines.
- Oral corticosteroids. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching — but are usually used only a short term for severe hives or angioedema because they can cause serious side effects. Topical corticosteroids usually aren't effective for chronic hives.
- Tricyclic antidepressants. The tricyclic antidepressant doxepin (Zonalon) has antihistamine properties and can help relieve itching.
- Epinephrine. For a severe attack of hives or angioedema, you may need an emergency injection of adrenaline (epinephrine) and a trip to the emergency room. If you have repeated attacks, despite treatment, your doctor may prescribe — and instruct you how to use — injectable adrenaline (EpiPen) to carry with you for use in emergency situations.
Other medications are still being studied to determine whether they may be useful for treating chronic hives. These include:
- Leukotriene receptor antagonists. Montelukast (Singulair) is the only medication of this type currently available in the United States. This type of medication may be helpful when used along with antihistamines.
- Cyclosporine. This immune system suppressant can help with symptoms, but it can cause serious side effects and needs to be monitored carefully.
- Omalizumab (Xolair). This medication is normally given by injection to treat allergic asthma. It may help people who have chronic hives caused by an autoimmune response that haven't been helped by antihistamines. Only very small studies have been completed, so more clinical trials are needed.
- Kaplan AP. Urticaria and angioedema. In: Wolff K, et al. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2958607. Accessed May 2, 2009.
- Urticaria. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec10/ch109/ch109e.html. Accessed May 2, 2009.
- Austen KF. Allergies, anaphylaxis, and systemic mastocytosis. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2858746. Accessed May 2, 2009.
- Bingham CO. Etiology and diagnosis of urticaria. http://www.uptodate.com/home/index.html. Accessed May 4, 2009.
- Urticaria. American College of Allergy, Asthma and Immunology. http://www.acaai.org/public/advice/urtic.htm. Accessed May 2, 2009.
- Fromer L. Treatment options for the relief of chronic idiopathic urticaria symptoms. Southern Medical Journal. 2008;101:186.
- Xyzal (prescribing information). Bridgewater, N.J.: Sanofi-Aventis. 2008. http://www.xyzal.com/pdf/pi.pdf. Accessed May 4, 2009.
- Sicherer SH. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2008. Journal of Allergy and Clinical Immunology. 2009;123:319.
- Khan DA. Chronic urticaria: Diagnosis and management. Allergy and Asthma Proceedings. 2008;29:439.
