With time, chronic hives (also called chronic idiopathic urticaria, or CIU) usually go away on their own, but there’s no medication to cure it. Treatments help with the pain and discomfort. Talk to your doctor about these options:
Antihistamines. These medications block histamine, a chemical in the skin that can cause allergy symptoms like hives.
Non-drowsy antihistamines. Your doctor will probably want you to try over-the-counter antihistamines like cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin) first. They don’t make you sleepy and usually only cause mild side effects, like dry mouth and eyes. It’s key to take these medications every day, not just when you have a breakout.
Nighttime antihistamines. If your hives are severe, your doctor may also recommend diphenhydramine (Benadryl) or a similar medicine. Because diphenhydramine can make you drowsy, your doctor will probably tell you to take it at night.
H2 antihistamines. Your doctor may tell you to take more than one type of antihistamine at a time to treat hives. Histamine blockers such as famotidine (Pepcid) or ranitidine (Zantac) can be used with others. These drugs are best known as heartburn treatments, but they also narrow blood vessels, which reduce the redness of hives. They may cause side effects like diarrhea, dizziness, and headaches.
Steroids. If antihistamines don’t help, your doctor might prescribe a corticosteroid. These drugs calm the immune system, making hives less severe.
You can get these medicines in a shot or in a pill. They can cause side effects like high blood pressure, weight gain, and sleep problems, which is why doctors usually give them at low doses and only for short periods of time.
Other options. Chronic hives can be difficult to treat. When antihistamines and steroids don’t work, there are a few more treatments that your doctor might suggest.
Asthma medications like montelukast (Singulair) or zafirlukast (Accolate) can help with hives that are aggravated by aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Just be aware of the side effects.
Omalizumab (Xolair) is approved for those who don’t get relief from antihistamines. Your doctor injects it under your skin. Experts think this biologic drug works by blocking a different type of immune system chemical that contributes to hives. Side effects include headache, upset stomach, a slight increase in heart disease/stroke, and rarely, anaphylaxis, a severe allergic reaction.
If those drugs don’t work, your doctor might try anti-inflammatory meds or an immunosuppressant, which curbs your immune system.
Together, you and your doctor can decide the best treatment plan for your chronic hives.