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Treatments and drugs

By Mayo Clinic staff

If your symptoms are mild, you may not need treatment. Many cases of hives and angioedema clear up on their own. But treatment can offer relief for intense itching, serious discomfort or symptoms that persist.

The standard treatment for hives and angioedema is antihistamines, medications that reduce itching, swelling and other symptoms of histamine release.

For severe hives or angioedema, doctors may also sometimes prescribe an oral corticosteroid drug — such as prednisone — which can help lessen swelling, redness and itching.

Antihistamines
Antihistamines are divided into older, first-generation drugs and newer, second-generation medications based on their chemistry and associated side effects. Each category includes nonprescription and prescription drugs.

Second-generation, newer antihistamines. Doctors generally recommend starting treatment with these newer, second-generation drugs. For most people, these drugs are less likely to cause drowsiness or reduce your reaction time while you're driving or performing other mentally or physically demanding tasks.

Nonprescription second-generation antihistamines include:

• Loratadine (Claritin, Alavert)
• Cetirizine (Zyrtec)

Prescription second-generation antihistamines include:

• Desloratadine (Clarinex)
• Fexofenadine (Allegra)
• Levocetirizine (Xyzal)

First-generation, older antihistamines. These medications tend to make you drowsy and respond more slowly than usual while driving or performing other tasks requiring physical coordination. In addition, they may cause dry mouth, blurred or double vision, constipation or difficulty passing urine. But they may be more helpful than second-generation antihistamines for some people with hives or angioedema, especially if your symptoms are severe or involve significant swelling of your face, tongue or throat. They may also be helpful taken at bedtime if your symptoms disturb your sleep.

Nonprescription first-generation antihistamines include:

• Diphenhydramine (Benadryl, others)
• Chlorpheniramine (Chlor-Trimeton, others)

Prescription first-generation antihistamines include:

• Hydroxyzine (Vistaril)

Treatment for hereditary angioedema
Antihistamines and oral corticosteroid medications — although useful in treating hives and acute angioedema — are often ineffective in treating hereditary angioedema. Medications used to treat hereditary angioedema on a long-term basis include certain androgens (male hormones), such as danazol, that help regulate levels of blood proteins.

The Food and Drug Administration (FDA) has also approved certain treatments targeting specific blood proteins that function abnormally in hereditary angioedema. These medications include:

• Cinryze and Berinert, two treatments derived from donated human blood plasma. Both drugs provide C1 esterase inhibitor, a blood protein that's inadequate or defective in hereditary angioedema. Cinryze is approved as a therapy to prevent hereditary angioedema attacks in adults and adolescents. It's taken as an injection by vein every few days and can be self-administered after training by a health professional. Berinert is approved to treat acute hereditary angioedema attacks affecting the face and abdomen while the attacks are under way. Berinert also is taken as an injection by vein, but it must be given by a health professional.
• Ecallantide (Kalbitor) is a protein derived from yeast. It blocks the activity of a blood protein called kallikrein, which is involved in hereditary angioedema. It's approved for adolescents and adults as a treatment to counter the effects of acute hereditary angioedema attacks on all body areas. Ecallantide is taken as an injection under the skin (subcutaneous) that must be given by a health care professional.

Emergency situations
For a severe attack of hives or angioedema, you may need a trip to the emergency room and an emergency injection of adrenaline (epinephrine). If you have had a serious attack or your attacks recur, despite treatment, your doctor may prescribe — and instruct you how to use — adrenaline to carry with you for use in emergency situations.

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