Let's Talk About Treatment and Medication for Chronic Hives
Chronic hives are like regular hives—except they last at least six weeks. Here's how to tame 'em so you can get on with life.
Chronic hives are a special kind hell. The angry, red welts come back for weeks or months at time, driving you to scratch and scratch till you're swollen. You might even hide under layers of potentially itch-inducing clothes so people can't wonder if you're contagious (you're definitely not!). So, deep breath. You’re looking for sweet relief, and we’re here to share everything we know. What treatments can help curb this skin condition? Which medications truly work? Read on—we’ve got you.
Our Pro Panel
We went to some of the nation's top CIU experts to bring you the most scientific and up-to-date information possible.
Purvi Parikh, M.D.
Adult and Pediatric Allergist and Immunologist
NYU Langone Health
New York City
Morgan Rabach, M.D.
Clinical Instructor in the Department of Dermatology
Mount Sinai Hospital
New York City
Ronald L. Ragotzy, M.D.
Allergist and Immunologist
Beloit Memorial Hospital
CIU can be treated — even prevented—but with no known cause, it’s difficult to say firmly that it can be cured. About half of patients with chronic hives stop experiencing symptoms within a year of CIU first appearing. .
If you suspect that a particular food or environmental allergen is the trigger, an allergy test is worth doing to either confirm or eliminate it as a cause. Usually, chronic hives have no confirmed cause—so there may be other triggers an allergy test won’t pinpoint.
Under your doctor’s guidance, you may take an antihistamine medication in conjunction with other drugs, including asthma medications, corticosteroids, monoclonal antibodies, immunosuppressants, and topical cremes that help relieve itching.
There are no proven natural remedies to actually cure CIU. However, treatments like taking a cool oatmeal bath, applying a water-and-baking-soda paste directly onto your welts, and using a cold compress may all help calm down skin and soothe the itching associated with a flare-up.
What Are Chronic Hives, Again?
If ever there were two words you’d never want to put together voluntarily, it’s chronic and hives. Because regular hives, a.k.a. acute hives, are annoying enough on their own. They’re red, swollen, and itchy, and they can appear anywhere on the body. Chronic hives are no different, except fresh crops of them appear on most days for at least six weeks and sometimes longer—for months or even years.
The medical term for this condition is chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU). Urticaria is just a fancy way of saying hives. Idiopathic means “no known cause.” So, chronic idiopathic urticaria are unremitting hives for which no one, not even your GP or allergist, can identify the specific trigger. All doctors know for sure is that something—heat, tight clothes, a super-sensitive immune system—throws the body's histamine response into overdrive, which means you end up covered in those itchy welts. (Normally, this reaction only occurs when you're exposed to an actual known allergen like a heavy fragrance or a bug bite.)
We know—not knowing exactly what triggers to avoid makes it even harder on you! Zeroing in on the cause of your chronic hives can be as agonizing as living with them—making finding the right treatment a top priority.
The good news is that there are several options for both short and long-term relief, and in some cases there are even ways of preventing an onset of CIU before that first red welt appears. Keep in mind that certain medications, particularly NSAIDS like aspirin, can actually trigger hives or make them worse. So, before running to the drugstore to help relieve the pain and itching, keep reading to learn which pills and topical cures doctors like best to treat this specific, sometimes tricky condition. And, remember, finding what works can take some trial and error. Hopefully, with these doctor-recommended tips, you’ll be on the fast track to finding a treatment that works for you.
What Are the Medications for Chronic Hives?
While there’s no single method to prevent chronic hives, a doctor can put you on a regular medication regimen, which may include a combination of over-the-counter (OTC) options you’re likely already familiar with, as well as some prescription drugs to help manage and prevent flares.
The most effective, and in most cases, quickest way to treat CIU is with antihistamines. Antihistamines work by blocking the histamine response, which can reduce symptoms or prevent an attack of chronic hives from happening. There are various OTC versions of this type of medication, but they pretty much all work in the same way. They often come in pill form for adults and in liquid form for children.
Non-drowsy options can have side effects such as dry eyes and mouth. They include:
Another OTC antihistamine is commonly used for chronic hives but is usually only taken at night, since it can make you drowsy:
Your doctor may also want you to try an H2 histamine blocker in conjunction with other antihistamines. These medications work by narrowing blood vessels, which calms redness. (They’re also routinely used for heartburn.) You can take them orally, or they can be given as a shot at your doctor’s office. Possible side effects include headaches and diarrhea. And P.S.: Don’t combine medications without your doctor’s supervision. Examples include:
Tagamet HB (cimetidine)
Drugs that treat asthma symptoms—wheezing, chest tightness, shortness of breath—are sometimes used to treat CIU, usually paired with an antihistamine. They work by blocking inflammatory molecules called leukotrienes, which are released when your body is having an immune response, causing swelling and redness in the airways and lungs. Your doctor might give you:
If antihistamines don’t do the trick, your doctor might move on to oral corticosteroids, which can help decrease swelling, redness, and itching. A common corticosteroid is called prednisone. It works by slowing your immune system response, calming inflammation along the way. For severe cases of CIU, this approach can be the quickest way to get hives in check. However, these drugs, given orally or by injection, are generally only used short-term—three to five days—to help get hives under control. That’s because if you take them for an extended period of time (weeks or months), you may experience serious side effects including:
Monoclonal antibodies for chronic hives work by attaching to immunoglobin (IgE), which your body produces in reaction to typically harmless substances, like pet dander. By doing so, it stops IgE from binding to the cells that trigger an allergic reaction, making you less reactive over time.
The monoclonal antibody drug Xolair (omalizumab) was approved by the U.S. Food and Drug Administration (FDA) in 2014 for use in chronic hives. This medication can be very effective against particularly stubborn cases of chronic hives. It's an injectable medicine, usually given once a month until hives subside. Although side effects aren’t common, there’s a possibility of joint pain, a mild rash where it was injected, and dizziness.
Use of these medications, like the drug Gengraf (cyclosporine), are only recommended for people with severe CIU who have cannot tolerate high doses of oral antihistamines and do not respond to conventional treatments. They work by hindering your immune response to reduce or stop symptoms. Cyclosporine is taken by mouth and can be used for up to 12 months. Possible side effects include an increased risk for infection. People with heart disease are prone to experiencing complications from immunosuppressants, so they’re generally not good candidates for this type of treatment.
Sometimes the quickest (if not necessarily long-acting) relief for chronic hives comes from direct, topical applications of:
Calamine lotion: Available without prescription—and used in some form or another since around 1500 BC—this pink treatment can help soothe itching as it calms the skin. It’s ingredients include zine oxide and ferric oxide. You can apply it directly to your hives, but shake the bottle well before you do, and allow the lotion to dry after application for best results.
Hydrocortisone cream: This steroid cream has anti-inflammatory effects and is often used for skin rashes of all types—and may help for chronic hives. OTC versions have formulations of up to 1%. (Higher concentrations are available by prescription.) Most over-the-counter (OTC) labels say you can use hydrocortisone cream for up to seven days. Ask your doctor what’s best for you.
Diphenhydramine anti-itch cream: This antihistamine is basically Benadryl in cream form, and it works by blocking the effects of histamine on the skin that causes itching.
Antidepressants: It might seem strange to consider using an antidepressant as a treatment for chronic hives, but for severe cases, drugs like Zonalon (doxepin) are sometimes used in a topical to help relieve itching. This medication works by blocking the histamine response.
Cold packs or cold compress: This super soothing, old-school technique can provide real relief from itchiness and help tame inflammation by constricting blood vessels to bring down puffiness. Another bonus? It works almost instantly and can be used as often as necessary.
Are There Other Treatment Options for Chronic Hives?
Lifestyle changes won’t cure what ails you when it comes to CIU, but they just might reduce symptoms and offer some much-needed relief from all that scratching and swelling. Here are a few non-Rx treatments you might also consider trying:
Change Your Diet
Even though only a small percentage of chronic hives cases can be linked to allergies or intolerance to specific foods, it can be helpful for folks with CIU to keep a food log. By doing so, you can try to rule out—and, yes, rule in—certain items as potential triggers. Some foods are common CIU-triggering culprits, including:
Fish (usually salmon, tuna, and cod)
Shellfish (including shrimp)
In addition, raw and uncooked foods can sometimes cause chronic hives in people who have oral allergic syndrome (OAS), far more often than cooked foods. That’s because allergic reactions to raw fruits or vegetables are related to allergies associated to the proteins found in tree pollen. The proteins found in food are similar in structure to those found in pollen, but are eliminated during the cooking and heating process.
Finally, certain additives or preservatives can trigger an immune response, even in foods you eat all the time, including:
Asparatame (Nutrasweet, a calorie-free sugar alternative)
Monosodium glutamate, or MSG (used to flavor packaged meats and other foods)
Parabens (used to preserve packaged foods)
Sulfites (commonly found in wine)
Tartrazine (a yellow dye commonly used in candy, desserts, cheese and canned vegetables)
There are a ton of reasons why wearing sunscreen every day is one of the best things you can do for your skin. Preventing and treating chronic hives is one of them. At the onset or even in the midst of a CIU flare-up, exposure to the sun can exacerbate already irritated, burning skin. That’s because the sun emits radiation and UV light that can trigger chemicals in the skin, causing a photosensitized reaction.
There is also a type of hives called solar urticaria (SU), which is a rare and chronic condition where exposure to ultraviolet or UV radiation—or sometimes even just visible light—induces a case of hives that can appear in both covered and uncovered areas of the skin. In this case, a dermatologist can prescribe either antihistamines to stop symptoms quickly or try a more preventative treatment plan, such as phototherapy, which uses UV light exposure to desensitize the skin. (But even with such treatments, don’t skip the SPF 50 when you venture outside, especially on hot and sunny days.)
Baby Your Skin
While overall skin care can’t prevent an outbreak of CIU, it can make you feel better if you’re having one. Make a point of only using hypoallergenic soaps, shampoos, and even laundry detergents—you want them to be as gentle as possible on sensitive skin.
Be Aware of Body Temperature
Intense exercise raises your body temp and increases blood flow, potentially triggering a histamine reaction and the appearance of hives. Hives from heat are known as cholinergic urticaria, and this condition means that you are super-sensitive to warmth, or to the response of sweating.
Still, we all need to exercise to stay healthy, so if you have this condition you might consider working out at home so you can control your environment. Crank up the AC; do mat work or use exercise equipment with a fan turned directly upon you; wear cool clothing; and have a cold glass of water at the ready. (And speak to your doctor about other preventative tips.) Remember, changes in temps—hot or cold—can also trigger CIU. So be careful with “icing” your body after a workout, or piping hot showers or baths to clean yourself up.
Try a (Cool) Bath Treatment
On that note, taking a bath can help soothe the symptoms of CIU—but only in water that’s room temp (or slightly warmer). That’s because, again, heat can trigger the dilation of blood vessels, causing blood pressure to drop as an increase in your blood supply allows hives to spread.
So, try soaking in lukewarm water with a cup of uncooked or colloidal oatmeal, which has anti-inflammatory and antioxidant properties. This is a quick and effective anti-itch and inflammation reducing solution, according to the Mayo Clinic. Baking soda works similarly, as it also has anti-inflammatory properties and essentially dries out the skin due to its alkaline properties, which provides relief from all that itching.
Be Open to Other Natural Remedies
According to hives.org, other products you’ll likely find around the house or at your local holistic retailer may help soothe the itch and inflammation. These include topical applications of:
Aloe vera lotion, which is loaded with vitamin E, can soothe skin, and can help stop itching.
Anti-astringents such as witch hazel, which may help shrink blood vessels near your welts.
Vinegar and water, applied directly to hives with a cotton ball, may help the itch go away.
Baking soda and water, made into a paste, can be slathered onto hives to help relieve itching.
Wear Loose Clothing
Tight-fitting clothing and elastic waistbands can irritate the skin of people with CIU. So think of it as an excuse to go to shopping or mix up your chronic hives wardrobe staples: Choose loose-fitting garments made of breathable materials like cotton. Ditch the too-snug jeans. And skip scratchy wool—your skin will thank you.
Better Manage Stress
According to the American Academy of Dermatology, too much stress and emotional turmoil can trigger hives...which can stress you out even more! If you're struggling, it can be worth having a few sessions with a therapist who can help you find coping strategies that fit with your life. And even if you don't need pro help, do your best to carve out some time every day to do something (anything!) that helps you decompress.
Will Medication and Treatments Make Chronic Hives Go Away for Good?
Both can help tremendously—but the honest answer is there’s always a chance your CIU could flare up again after years of being dormant. The good news? Half of all people with chronic hives stop experiencing symptoms and flare-ups altogether within 12 months of their first CIU attack. That may seem like an eternity right now when you’re dealing with itchy, irritated skin, but there is hope that once it’s gone, it’s gone for good.
- About CIU: Mayo Clinic. (n.d.). “Chronic Hives.” mayoclinic.org/diseases-conditions/chronic-hives/diagnosis-treatment/drc-20352723
- CIU Treatment (1): World Allergy Organization Journal. (2012). “Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective.” waojournal.biomedcentral.com/articles/10.1097/WOX.0b013e3182758d6c
- CIU Treatment (2): American Academy of Dermatology. (n.d.). “Ten Ways to Get Relief From Chronic Hives.” aad.org/diseases/a-z/hives-chronic-relief
- CIU Treatment (3): Advances in Dermatology and Allergology. (2018). “Stress, Itch, and Quality of Life in Chronic Urticaria Females.” ncbi.nlm.nih.gov/pmc/articles/PMC5949545/
- CIU Treatment (4): Indian Journal of Dermatology. (2009). “Chronic Urticaria and Treatment Options.” ncbi.nlm.nih.gov/pmc/articles/PMC2807703/
- Allergic Food Reactions: Asthma and Allergy Association of America. (n.d.). “Adverse Reactions to Food Additives.” asthmaandallergies.org/food-allergies/adverse-reactions-to-food-additives/
- Natural Remedies for CIU: Hives.org. (n.d.) “How to Get Rid of Hives Fast.” hives.org/how-to-get-rid-of-hives.php
- CIU and Stress: The American Academy of Dermatology. (n.d.). ”Who Gets and Causes.” aad.org/public/diseases/a-z/hives-causes