How to Treat Hives
Hives are a common condition — roughly 20 percent of people will deal with them at some point in life. But they’re also downright annoying, even uncomfortable to the point where sleeping, working, going to school, and socializing may be compromised. (1) Fortunately, there are numerous treatment options available, including some you can do on your own at home.
Hives can show up as a solo lesion or in clusters. While they may seem alarming, most hives disappear within 24 hours. (2) There’s not much you can do to make them go away more quickly during that time. But there are steps you can take to relieve the itching and perhaps prevent another hive from coming. (3)
A 24-hour over-the-counter antihistamine like loratadine and pseudoephedrine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra), or a short-acting allergy medication like diphenhydramine (Benadryl) can help relieve itching and discomfort, says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston.
Antihistamines are designed to reduce or block histamine, a chemical in your body that’s responsible for hives’ welt-like bumps and itching. If you break out in hives again after the medicine wears off, take it for three to five days and then stop to see if you get more hives. If so, you should see your doctor, Dr. Elmariah says — and you can continue taking the antihistamine until you do so or your doctor tells you otherwise.
“Taking medication at this point is more about preventing another [hives outbreak] versus treating the existing one,” says Adam Friedman, MD, a professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.
But don’t reach for aspirin and nonsteroidal anti-inflammatory drugs, as they could make your hives worse, he says.
And don’t be tempted to try topical therapies, either. “Hydrocortisone may help a little; Neosporin, as an antibiotic, will do nothing other than kill the normal bacteria on the skin; and topical Benadryl has been known to cause contact dermatitis (an allergic reaction that looks like eczema),” Dr. Friedman explains.
One of the most important steps in managing hives is resisting the urge to scratch that itch. Doing so could break open the hive, which could put you at risk of infection, Friedman says. Ice therapy in the form of a cold compress or a bag of frozen peas is the best way to tamp down the itchiness.
Moisturizing the skin may have a cooling effect — even more so if you chill the moisturizer in the fridge first, says Anthony M. Rossi, MD, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City. (You may want to skip this remedy, though, if you get cold urticaria, hives that result from exposure to cold. In this case, skip cold therapy.)
If you have any breathing issues, you should seek immediate medical attention. Hives are often associated with a severe allergic reaction called anaphylaxis and a condition called angioedema, where tissue in your face, lips, tongue, throat and even genitals can swell. (Other signs of angioedema include joint swelling, deep tissue pain, and wheezing.) Both conditions warrant a trip to the emergency room. (1,3)
Also, if you have abdominal pain or fever associated with hives, seek immediate medical care, Elmariah says.
If you have only one outbreak of hives and you don’t have breathing difficulties, you probably don’t need medical attention. Yet if you continue to get multiple bouts of hives that continue after a couple of weeks, you may want to call a doctor, Elmariah suggests. “Most often, the hives will resolve during this time or you’ll figure out what’s causing them.”
But hives that continue for weeks warrant a trip to a specialist, such as a dermatologist or an allergist. If they continue for six weeks or longer they’re considered chronic hives, which tend to be caused by the same triggers as short-term or acute cases of hives. Because dermatologists and allergists are skilled at working with hives, they’re your best bet for getting appropriate treatment, Dr. Rossi explains.
Expect to undergo a thorough physical exam. The dermatologist or allergist will also likely ask you to review your hives experience in detail, including when the hives started, if you suspect anything in particular triggered your hives, what medications you’ve tried, and what type of response you’ve gotten. Come prepared with this information.
Doctors will also verify that the bump (or bumps) is hives, often circling the spot on your skin to see if it disappears the next day (if so, it’s a hive, Elmariah says).
Once they’ve confirmed that it is hives, they’ll work to determine the trigger. Rossi says: “Figuring out the cause can be the most frustrating part of it, especially if the tests aren’t helpful.”
You may require additional testing. If an allergy is suspected, you may need to undergo allergy testing. If you are diagnosed with a severe allergy, the doctor may prescribe an epinephrine auto-injector (such as an EpiPen) in case you’re accidentally exposed to your allergen. (1)
And because chronic hives can signal autoimmune disorders, you may need to have a blood draw in which doctors will look for a common antibody found in many autoimmune disorders. In rare cases when a bout of hives doesn’t disappear within 24 hours, your doctor may do a skin biopsy to see if there’s inflammation of the blood vessels, Rossi adds.
Doctors usually prescribe antihistamines as the first course of treatment for hives. Acute cases can generally be treated with over-the-counter antihistamines like loratadine and pseudoephedrine, cetirizine, fexofenadine, or diphenhydramine.
If your hives are persisting (or you’ve already tried OTC antihistamines without success), your doctor may move to another class of antihistamines called histamine type 2 receptor antagonists, or H2 blockers, including cimetidine (Tagamet) and famotidine (Pepcid) (both available over the counter); up the dose of antihistamines (some as high as four times); or combine several antihistamines, Friedman says.
In some cases, your doctor may prescribe an oral steroid, such as prednisone (Deltasone), if your hives still aren’t responding. Oral steroids are stronger but can cause more significant side effects than antihistamines. (3)
If you’re still not seeing results, your doctor may recommend even stronger medications, like an injectable prescription medication called omalizumab (Xolair). There is also evidence that off-label use of stronger medications that suppress the immune system under careful monitoring by a specialist may be helpful in patients with difficult-to-manage hives.
It’s important to note that you shouldn’t try taking high doses of vitamins or any other off-label medication on your own without instruction from your doctor. No one treatment works for everyone, Friedman says. And for some, such therapies may not be safe.
The best prevention strategy is perhaps the most obvious: Avoid your triggers.
For example, if pressure on your skin gives you hives, skip the tight clothing and opt for looser-fitting clothes. If the sun is your trigger, avoid too much direct sun when you can and always wear sunscreen, which is a wise idea even if you’ve never gotten a hive in your life, Elmariah says.
If dermatographism, otherwise known as scratching the skin, is making you break out, avoiding wool, irritating chemicals and fragrances, and harsh soaps, and using emollients to hydrate your skin can certainly help, she adds.
Getting hives every time you exercise? Consider taking a long-acting antihistamine like cetirizine before your workout and exercising in an air-conditioned facility. “You’ll still sweat and you could get hives, but by surrounding yourself with cooler temperatures, you’ll reduce the symptoms,” Elmariah says.
Hives affect nearly one in five people and can significantly disrupt one’s daily activities due to itching and discomfort. While hives typically disappear within 24 hours, over-the-counter antihistamines can provide symptom relief and help prevent future outbreaks. Remember, the best way to manage hives is to identify and avoid your specific triggers.
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