Hives, or urticaria, are a common skin rash that appears as raised, itchy welts. Sometimes, hives resolve quickly on their own, but if they persist, over-the-counter medications often help.
Hives (urticaria) are raised, itchy skin welts that can arise suddenly on any part of the body.
Odds are you’re familiar with this common, and usually temporary, skin eruption. Research estimates that there is up to a 15% to 20% chance you’ll be affected by acute hives at some point in your life.
Hives can be caused by a wide range of irritants, including allergens, infections, medications, or even temperature changes.
But ultimately, each of these triggers causes hives by activating your immune system’s mast cells. Mast cells then release inflammatory mediators, including histamine, which cause itching and swelling in your skin.
In many people, episodes of hives last just minutes to hours. But sometimes, hives can become a recurrent problem for weeks or even months.
The good news is that multiple medications are available to help treat hives and manage your symptoms.
Antihistamines are the first-line treatment for hives. These medications combat the underlying cause of hives by blocking your body’s histamine receptors. Many oral antihistamines are available over the counter.
Second-generation antihistamines:
These antihistamines cause less drowsiness and fewer side effects than their first-generation counterparts and are the preferred option for treating itchiness from hives.
Options include:
- cetirizine
- levocetirizine
- loratadine
- desloratadine
- fexofenadine
These medications are available in liquid, chewable, and tablet forms.
Most second-generation antihistamines can be taken by mouth once every 12 to 24 hours. Doctors recommend starting with the standard, over-the-counter dose found on your medication bottle. But if this doesn’t provide enough relief, contact your doctor. You may be eligible to safely increase to a higher dose.
Continue taking second-generation antihistamines regularly until your hives completely resolve. You can stop your antihistamines once no new hives have appeared for a day or two. If you have been taking them multiple times per day for several days or more, you may wish to taper off gradually.
Second-generation antihistamines are very effective for treating hives. Some people need only a single dose, and most will not need treatment for more than 2 to 3 weeks.
But if your hives don’t resolve on these medications, or frequent hives persist for longer than 6 weeks, contact your doctor for more information and treatment options.
First-generation antihistamines:
These medications also work well to treat hives.
But compared with second-generation antihistamines, they last only a short time, requiring more frequent dosing. And because they can cross into the brain, first-generation antihistamines are more likely to cause significant side effects.
Commonly used first-generation antihistamines include:
- diphenhydramine
- hydroxyzine
- chlorpheniramine
If you have hives, doctors generally recommend starting with a second-generation antihistamine instead. But if first-generation medications are more readily available, you can start there. Be sure to monitor for side effects like:
- drowsiness or sedation
- impaired reaction time
- dry mouth
- urinary retention
- vision changes
- dizziness
- changes in alertness or confusion (particularly in young children and older adults)
Do not operate a motor vehicle or use heavy machinery until you know how first-generation antihistamines affect you.
Do not give first-generation antihistamines to children under 2 years of age without first talking with your doctor.
If your hives are not getting better with oral antihistamines, your doctor may decide to prescribe a short course of oral glucocorticoids (steroids).
Oral steroids are anti-inflammatory, reduce swelling, and may decrease mast cell and tissue histamine content.
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Prednisone
Oral prednisone is usually prescribed as a pill, taken by mouth, for a period of 5 to 7 days. Your doctor will determine the right dose for you based on your symptoms, age, and weight.
Side effects of short-course oral steroids for hives may include:
- stomach upset
- vomiting
- headache
- anxiety
- fatigue or sedation
With prolonged use, oral steroids can result in more serious systemic side effects.
These skin creams, lotions, or ointments may be helpful as a secondary treatment for hives. They might be recommended in addition to your oral antihistamines.
Topical corticosteroids have multiple anti-inflammatory effects that can reduce swelling and itch, and may downregulate mast cells.
A 2024 review suggests topical corticosteroids may help reduce hives severity (size) and itchiness. No significant side effects were seen with the use of medium-to-high potency topical corticosteroids for around 3 weeks. However, authors note that more research needs to be done to confirm this since only three studies were included in the review.
Topical hydrocortisone
Hydrocortisone (0.1% to 1%) is the only over-the-counter topical steroid available in the United States. Hydrocortisone cream, ointment, or lotion can be found in the skin care aisle of your pharmacy.
Apply a thin layer to hives, avoiding any open cuts or sores. Follow label instructions closely. Usually, you can reapply up to two to four times daily. Contact your doctor for advice if you are consistently using over-the-counter topical hydrocortisone for more than 1 to 2 weeks.
Over-the-counter topical hydrocortisone is a very low potency topical steroid. Side effects are uncommon, especially when it is used for short periods of time. Side effects of topical steroids may include:
- burning or stinging sensation
- skin lightening or darkening
- acne
- rosacea
- thinning of the skin
- stretch marks
Prescription topical steroids
A wide range of prescription topical steroids is available. Your doctor will help you decide if adding a prescription topical steroid is right for your hives treatment regimen.
Because prescription steroids are more potent, they may be more likely to cause the side effects above, particularly with prolonged use. Follow your doctor’s instructions for use carefully.
Extremely rarely, prolonged use on large areas can lead to more serious side effects from absorption into your bloodstream:
- glaucoma
- high blood pressure
- high blood sugar
- suppression of your body’s own steroid production
- Cushing syndrome
Commonly used prescription-strength topical steroids include:
- hydrocortisone
- desonide
- alclometasone
- fluocinolone
- triamcinolone
- betamethasone
- mometasone
Omalizumab is a treatment option for people who develop chronic hives that are not well-controlled on antihistamines.
Chronic hives are daily or frequent hives that last more than six weeks.
Omalizumab is a monoclonal antibody therapy that binds to your own immunoglobulin E (IgE) antibodies. IgE is part of your immune system and plays a significant role in some allergic reactions. Omalizumab works by inhibiting your IgE.
This medication is administered as a monthly injection in doses of
Omalizumab is quite safe overall. But in very rare cases, it may cause a life threatening allergic reaction called anaphylaxis. This is why your first series of doses must be given under close supervision in your doctor’s office.
More common side effects include:
- headache
- sore throat
- upper respiratory infection
- nausea
- joint pains
- cough
The American Academy of Dermatology recommends trying these tips at home to relieve itchy hives:
- Avoid overheating.
- Choose loose-fitting, breathable cotton clothing.
- Try a colloidal oatmeal bath in lukewarm water.
- Take warm (not hot) baths or showers, and avoid scrubbing the skin.
- Choose fragrance-free, gentle skin care products.
- Keep skin well-moisturized with fragrance-free lotion or cream.
- Apply a cold compress (such as a cool cloth or ice in a towel) to itchy hives.
- You can try over-the-counter anti-itch products, such as calamine lotion or a cream containing pramoxine (if your doctor has approved them).
Hives are a common skin rash that can be intensely itchy and irritating. When outbreaks of hives persist or are frequently recurrent, they can impact your sleep, quality of life, and overall well-being.
Doctors typically recommend non-drowsy oral antihistamines, such as cetirizine or loratadine, as the first-line treatment for hives. These medications can easily be found over the counter.
When hives persist, a cold compress and application of a topical steroid cream like 1% hydrocortisone may also be helpful.
If your hives aren’t responding to these treatments or if you suspect a more serious or progressive allergic reaction, contact your doctor right away.
Most episodes of hives are acute and resolve on their own within a few weeks. But if your hives are severe or persistent, your doctor may recommend prescription-strength topical, oral, or injectable treatments.