Hives, or urticaria, are raised, itchy welts that appear on the skin. They can vary in size, shape, and color, and may appear suddenly. Hives are often triggered by an allergic reaction, though they can also be caused by stress, infections, or environmental factors. While hives are usually harmless and go away on their own, they can be uncomfortable and sometimes require treatment. If you’re dealing with hives, it’s important to understand the different types of medications that can help manage symptoms.
This article will explain the various medications that can be used to treat hives, how they work, and which ones might be most effective depending on the severity of the condition.
Antihistamines: The First Line of Defense
The most common and effective treatment for hives is antihistamines. These medications work by blocking the effects of histamine, a chemical released by the body during an allergic reaction. Histamine is responsible for causing itching, swelling, and redness. By preventing histamine from binding to receptors in the skin, antihistamines can relieve the symptoms of hives.
Over-the-Counter Antihistamines
Many antihistamines are available over the counter and are often the first treatment recommended by doctors for mild cases of hives. Some of the most commonly used over-the-counter antihistamines include:
Loratadine (Claritin): This non-drowsy antihistamine is widely used for treating allergies and hives. It works by blocking histamine receptors in the body and can provide relief from itching and swelling.
Cetirizine (Zyrtec): Similar to loratadine, cetirizine is effective at treating hives. It’s also a non-drowsy option, although some people may experience mild drowsiness.
Fexofenadine (Allegra): Another non-drowsy antihistamine, fexofenadine is useful for controlling itching and swelling due to hives. It is often well-tolerated and works quickly.
Diphenhydramine (Benadryl): While this antihistamine is effective for treating hives, it can cause significant drowsiness. It is typically recommended for short-term relief or if sleep is needed. It is not ideal for daytime use.
Prescription Antihistamines
For more severe cases of hives or if over-the-counter medications are not effective, doctors may prescribe stronger antihistamines. These medications are similar to the over-the-counter versions but may be more potent or have different formulations.
Desloratadine (Clarinex): This prescription antihistamine is a stronger version of loratadine and can provide relief for more persistent cases of hives. It works by reducing the inflammatory response caused by histamine release.
Hydroxyzine (Atarax): Hydroxyzine is a sedating antihistamine often prescribed for severe allergic reactions. It can help calm the skin’s response to hives and is sometimes used for short-term relief when hives are particularly troublesome.
How Antihistamines Help with Hives
Antihistamines block the histamine receptors in the skin, which reduces swelling, redness, and itching. By doing this, they can relieve the most common and bothersome symptoms of hives. Antihistamines can be taken as pills, liquids, or sometimes as topical creams, depending on the severity of the symptoms and the individual’s preferences.
Corticosteroids: For Severe or Chronic Cases
In cases where antihistamines are not enough to control hives, doctors may recommend corticosteroids. These medications are powerful anti-inflammatory drugs that can help reduce swelling, redness, and itching associated with severe allergic reactions.
Corticosteroids work by suppressing the immune system and reducing the inflammatory response that occurs during an allergic reaction. They are usually prescribed for short-term use to avoid potential side effects associated with long-term use, such as weight gain, high blood pressure, and increased risk of infection.
Oral Corticosteroids
For more persistent or severe cases of hives, oral corticosteroids are often prescribed. Common examples include:
Prednisone: This is one of the most commonly prescribed corticosteroids for treating severe hives. It works quickly to reduce inflammation and relieve itching and swelling. Prednisone is often prescribed for a short course (typically 5-10 days).
Methylprednisolone (Medrol): This corticosteroid is another option that may be prescribed for hives that are resistant to antihistamines. It is often used for short periods to avoid the potential long-term side effects of steroids.
Topical Corticosteroids
In addition to oral steroids, topical corticosteroids can also be applied directly to the skin. These are typically used for localized areas of hives that are causing irritation. They can help reduce inflammation and calm the skin. Some common topical corticosteroids include:
Hydrocortisone cream: Available over the counter in lower strengths, hydrocortisone is a mild corticosteroid that can be used for localized cases of hives.
Betamethasone and Triamcinolone: These stronger topical corticosteroids are available by prescription and may be used for more severe or persistent hives that do not respond to other treatments.
When Are Corticosteroids Necessary?
Corticosteroids are typically reserved for short-term use when antihistamines do not provide adequate relief. They are particularly helpful in cases of chronic hives or when hives are accompanied by swelling that is more severe (such as in the case of angioedema). However, due to the potential side effects, they are generally not recommended for long-term use.
Leukotriene Receptor Antagonists: Alternative for Chronic Urticaria
For people who experience chronic or long-lasting hives, leukotriene receptor antagonists may be considered. These medications work by blocking leukotrienes, which are chemicals involved in inflammation and allergic reactions.
Montelukast (Singulair)
Montelukast is a leukotriene receptor antagonist often used to treat asthma and allergic rhinitis, but it can also be effective in treating chronic hives. It works by blocking leukotrienes, which contribute to inflammation and allergic responses in the body. This medication may be prescribed in combination with antihistamines for more severe cases of chronic hives.
How Leukotriene Receptor Antagonists Help
Leukotriene receptor antagonists like montelukast are especially useful for people who experience chronic hives that last for more than six weeks. By inhibiting leukotrienes, these medications help to reduce both inflammation and the frequency of flare-ups.
Biologic Medications: A Newer Approach for Severe Hives
For individuals with severe, chronic hives that do not respond to antihistamines, corticosteroids, or leukotriene receptor antagonists, biologic medications may be an option. Biologics are a newer class of drugs that are specifically designed to target the immune system and reduce inflammation.
Omalizumab (Xolair)
Omalizumab is a biologic medication that targets IgE, an antibody that plays a central role in allergic reactions. It is used for chronic urticaria (hives) that does not respond to traditional treatments. Omalizumab is typically injected once a month and works by preventing IgE from triggering an allergic response.
How Biologics Work
Biologic medications like omalizumab are often used as a last resort when other treatments have failed. These medications can provide long-term relief for individuals with severe, chronic hives. Since biologics are relatively new, they may come with a higher cost and require administration in a healthcare setting.
Epinephrine: For Anaphylactic Reactions
In some rare cases, hives can be associated with a severe allergic reaction called anaphylaxis, which can be life-threatening. Anaphylaxis may cause symptoms like difficulty breathing, a drop in blood pressure, and swelling of the throat. In such situations, epinephrine is used to rapidly reverse the symptoms.
When Is Epinephrine Needed?
Epinephrine is typically administered via an auto-injector (such as an EpiPen) in cases of anaphylaxis. While hives alone are not typically life-threatening, if they are accompanied by difficulty breathing or swelling of the throat, epinephrine may be necessary to prevent the reaction from becoming more severe.
Home Remedies and Lifestyle Changes
In addition to medications, certain home remedies and lifestyle changes can help reduce the frequency and severity of hives.
Cool Compresses: Applying a cool compress to the affected area can help relieve itching and reduce inflammation.
Oatmeal Baths: Taking an oatmeal bath can soothe irritated skin and reduce itching.
Avoid Triggers: Identifying and avoiding triggers, such as certain foods, medications, or stress, can help prevent hives from recurring.
Loose, Comfortable Clothing: Tight clothing can irritate the skin and worsen hives, so it’s best to wear loose-fitting clothing made of soft materials like cotton.
Conclusion
The best medication for treating hives depends on the severity of the condition, the cause of the hives, and individual preferences. For most people, antihistamines will be sufficient to control symptoms, but for more severe cases, corticosteroids, leukotriene receptor antagonists, or biologics may be needed. If hives are accompanied by severe symptoms such as difficulty breathing, immediate medical attention is necessary. Always consult with a healthcare provider to determine the most appropriate treatment plan for your specific situation.
Related topics:
