What Are the Best Treatments for Chronic Hives?

Hives, which are scientifically known as urticaria, are itchy welts on the skin. These welts are also called wheals, and they can occur anywhere on the body. In addition, their appearance can vary in shape, size, and color. Hives may appear as small spots, blotches, or even thin, raised lines, and they may be red, pink, white, or skin-toned in color. There are numerous causes of hives, including allergens (e.g., food, medication, insect bites), physical triggers (e.g., heat, cold, moisture, pressure), and underlying medical conditions (e.g., viral infections, parasitic infections, autoimmune diseases). Typically, hives appear quickly and then clear up within a few hours or days. However, hives that repeatedly recur over a six-week period or longer are classified as chronic hives, or chronic urticaria.

What Causes Hives?

As mentioned above, many things can cause hives. Common causes include:

Allergens: Exposure to an allergen, or something that the body views as foreign or dangerous, can elicit an allergic reaction and result in hives. An allergic reaction can happen if a specific food, medication, or substance is ingested. Similarly, hives can be caused by an allergen that comes into contact with the skin (i.e., contactants) or that is inhaled (i.e., aeroallergens). Common allergens that fall into these categories are listed below.
- Food allergens: Shellfish, fish, peanuts, chocolate, eggs, milk, soy, tomatoes, berries, and wheat
- Medication/substance allergens: Antibiotics, opioids, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors, oral contraceptives, narcotics, and alcohol
- Contactants: Latex, plants, animals/dander, topical medications, chemicals, and food.
- Aeroallergens: Pollen, mold, and dander.
Physical triggers: Mechanical stimulation can sometimes cause hives in individuals. Common physical triggers include:
- Heat
- Cold
- Water
- Sun exposure
- Exercise
- Vibration
- Pressure

Underlying medical conditions: Chronic hives have been associated with numerous autoimmune diseases (e.g., systemic lupus, rheumatoid arthritis, autoimmune thyroid disease) as well as many viral, bacterial, and fungal infections. Similarly, certain neurological disorders, including fibromyalgia, have been linked to chronic hives.
Psychological factors: Psychological distress, such as stress, anxiety, or depression, has been shown to trigger or aggravate hives.

Despite these common triggers, more often than not, chronic hives are idiopathic in nature. This means that the cause is unknown. However, even if this is the case, certain treatments and remedies may still work.

What Are the Best Treatments for Hives?

The best treatment for hives may vary for each individual. Therefore, treatment regimens should be specifically tailored. Nonetheless, the most common treatments include:

Antihistamines: These medications work by blocking the release of symptom-causing histamine from immune cells. Many antihistamines are available over the counter, including cetirizine (Zyrtec), loratadine (Claritin), and Benadryl. However, stronger antihistamines can be prescribed by a doctor if the over-the-counter medications fail to alleviate symptoms. It should be mentioned that although many antihistamines do not cause drowsiness, some do and are therefore best taken before bedtime.
Topical treatments: Anti-itch creams or lotions, such as hydrocortisone, menthol, or Benadryl creams and calamine lotion, can be applied to hives for temporary relief. The antidepressant doxepin has also been shown to effectively relieve itch when applied topically. Topical anesthetics, such as lidocaine, may also provide some relief from prolonged itching and pain.
Corticosteroids: Oral corticosteroids, such as prednisone, may be prescribed by a doctor to reduce inflammation and treat severe hives. However, these medications are typically only used for immediate, short-term control of the hives because serious side effects often accompany their long-term use.
Leukotriene inhibitors: White blood cells release inflammatory leukotrienes when they are activated by histamines. Leukotriene inhibitors, including montelukast (Singulair) and zafirlukast (Accolate), are commonly prescribed to treat asthma, but they have also been shown to be useful for treating chronic hives. These prescription drugs come as a single-dose pill that is taken once a day and that can be combined with antihistamines.
Monoclonal antibodies: Omalizumab is a synthetic antibody that binds to and inhibits the antibodies responsible for the release of histamine. This medication is injected subcutaneously once a month by a medical professional to treat chronic hives.
Epinephrine: An epinephrine auto-injector, commonly known as an EpiPen, is used to immediately treat severe, life-threatening reactions. These are prescribed by a doctor, and emergency treatment must follow their use.
Light therapy: This treatment is also called phototherapy, and it uses ultraviolet (UV) light to treat hives. It requires several doctor visits a week over a duration of a few months. However, this therapy has been shown to be effective for treating chronic hives when antihistamines have failed.
Other medications: If antihistamines and other treatments fail, other medications that target the immune system may be prescribed to treat chronic hives. These include cyclosporine, hydroxychloroquine, and tacrolimus, all of which work to suppress the immune response.

What Are Some Home Remedies for Hives?

Whether they are chronic or not, hives cause extreme discomfort. Below are some tips and home remedies that may help with the treatment of hives and that may also offer some relief from the itching and pain:

Avoid scratching: Even though this may be difficult, not scratching the hives can prevent further irritation and damage to the skin. Scratching also worsens the hives because it induces the production of more histamines.
Wear loose-fitting, breathable clothes: This can prevent irritation from rubbing or becoming too warm. A good choice is clothing made of 100% cotton.
Take an oatmeal or baking-soda bath: Colloidal oatmeal and baking soda are great for treating hives because they have antiinflammatory properties. Adding either of these to a cool or lukewarm bath and soaking for about 10 to 15 minutes can soothe the skin and ease any itching.
Apply a cold compress: An ice pack or cool, moist washcloth can be applied to the skin to offer quick relief from the pain and itch caused by hives. The compress should be left on the affected area for about 10 to 20 minutes, and it can be reapplied as needed.
Use an anti-itch cream or lotion: As mentioned above, an anti-itch cream or lotion can be used to ease the discomfort from hives. Many over-the-counter options are available, but a paste can also be made with baking soda and/or colloidal oatmeal.

How Can Hives Be Prevented?

Avoid triggers: Identifying and avoiding anything that causes hives is the most important measure for preventing future outbreaks. Keeping a journal can be helpful when trying to identify triggers. It should include when and where the hives occurred as well as any relevant foods, activities, medications, etc.
Use gentle, fragrance-free soaps and cleansers: Fragrances can often irritate the skin and cause reactions, so it is best to avoid using products that contain them. Scented laundry detergents are also common culprits of hives that often get overlooked.
Use lukewarm water: Showering or bathing with lukewarm water is important for preventing hives because water that is too hot can irritate and dry out the skin.
Prevent dry skin: Applying a gentle, fragrance-free moisturizer throughout the day can prevent dry skin that is more susceptible to developing hives.
Use sunscreen: Applying sunscreen before going outdoors can not only prevent a sunburn, but it can also prevent irritation from the sun’s UV rays that can elicit a hives flareup.
Avoid stress: This is usually easier said than done, but stress can aggravate or even trigger hives. Taking some time for simple breathing exercises or meditation may help.

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