Treatment Options for Chronic Hives

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Chronic urticaria, or hives, is the occurrence of hives for at least six weeks. Many people have what is known as idiopathic chronic urticaria, meaning that the cause of the hives is unknown. Because of this, treatment is based on symptom control, according to a 2015 report completed by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology.


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H1 antihistamines

H1 antihistamines, which block histamines in the body, are an effective treatment option for some people with chronic hives, according to a study published in the journal Clinical and Translational Allergy. Researchers began with one dose of an antihistamine a day and found that some people required four times that dose for symptom relief. Even at the higher dose, some people in the study did not respond to the treatment at all.


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Xolair (omalizumab)

The Food and Drug Administration (FDA) approved the biologic medication Xolair (omalizumab) for the treatment of chronic hives in those 12 years of age or older in 2014. This is a once-monthly injectable medication and is used for those who have not responded to H1 antihistamines.


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Tricyclic antidepressants

Tricyclic antidepressants are older antidepressant medications that have been found to help some people with chronic hives, according to a report published in the World Allergy Organization Journal.


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Immunosuppressant medications

Chronic hives may be an autoimmune reaction in some people. For them, immunosuppressant medications may be of benefit. According to a report published in the World Allergy Organization Journal, it can take up to three to five weeks for the benefit to be noticeable. Immunosuppressant medications do have side effects. You should be closely monitored by a doctor when taking these types of medications.


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Corticosteroids

Oral corticosteroids, when used for short-term use of three to five days, may help in controlling acute symptoms according to a 2015 report completed by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology.


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Other medications

There are a few other medications, such as leukotriene receptor antagonists and ciclosporin, which can be tried if other treatments are not successful, according to a 2015 report completed by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology.


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Avoidance of triggers

Although the underlying cause of chronic hives may be unknown, some people experience outbreaks from certain triggers, such as heat or consumption of NSAIDS. When those triggers are known, steps should be taken to avoid them, according to a 2015 report completed by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology.


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Eating a low-histamine diet

Eating a low-histamine diet may decrease symptoms and improve quality of life, according to a study published in Dermatology News. A low-histamine diet omits food such as cheese, preserved meats, strawberries, raspberries, citrus fruit, bananas, kiwis, plums, papaya, and alcohol. It includes foods such as dairy, vegetables, fresh meat, eggs, bread, pasta, rice, and certain varieties of fish.


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Vitamin D

High doses of vitamin D were found to significantly reduce symptoms of chronic hives according to a study completed at the University of Nebraska Medical Center. This was especially true when vitamin D was added to anti-allergy medication. People in the study who received the most benefit took 4000 IUs for three months.