Urticaria (hives) - Treatment 

Treating urticaria 

Most cases of urticaria will not need to be treated as the symptoms are mild and the condition often gets better on its own within a few days.

Short-term urticaria

If the symptoms of acute urticaria are more serious or the condition persists, you can buy antihistamine medication over-the-counter at pharmacies. Speak to your pharmacist, or see your GP if your symptoms get worse.

Your GP may prescribe corticosteroid tablets, although you should return to your GP if the symptoms get worse or treatment hasn't worked after two weeks.

Antihistamines

Antihistamines block the effects of histamine, so they should stop the symptoms of itchiness and reduce the rash. Examples of antihistamines include:

  • cetirizine
  • fexofenadine
  • loratadine

Modern antihistamines do not cause drowsiness in most people, but there are some exceptions. See how you react to the antihistamine before driving or operating heavy machinery. Modern antihistamines may cause drowsiness if taken with alcohol. Always read the information leaflet for your medication.

If you are having problems sleeping at night because of particularly itchy urticaria, your GP may give you additional antihistamines that are known to cause drowsiness, such as chlorphenamine or hydroxyzine.

Antihistamines are normally not prescribed during pregnancy. This is because they have not been established as being entirely safe. However, your GP may recommend chlorphenamine if they feel the benefits outweigh the risk.

There are several thousand known cases of pregnant women taking chlorphenamine, and there is no evidence that it harms unborn babies.

Corticosteroid tablets

You may be prescribed a short course of high-dose corticosteroid tablets, such as prednisolone, if your symptoms are severe.

Corticosteroids suppress your immune system and, therefore, can suppress the symptoms of urticaria.

Usually, a three- to five-day course of prednisolone is recommended.

Taking steroid tablets on a long-term basis is not usually recommended as this can lead to a wide range of side effects and complications, such as high blood pressure, glaucomacataracts and diabetes (or it can make existing diabetes worse).

Long-term urticaria

Treatment for chronic urticaria involves helping you control your symptoms and avoiding any triggers that make the symptoms worse.

If you have chronic urticaria and angioedema (swelling of a deeper layer of skin), you may also be referred to a dermatologist (specialist in skin conditions). This is because angioedema is potentially more serious as it can cause breathing difficulties.

If you only have chronic urticaria but the symptoms persist despite treatment, you should also be referred.

Antihistamines

The symptoms of chronic urticaria are treated with antihistamines. You may have to take them regularly for as long as the symptoms last. As with acute urticaria, you may be given a combination of non-drowsy and drowsy antihistamines to help you sleep.

If your symptoms do not respond to treatment, it may be recommended that you increase your dosage.

Increasing the dose can often help control symptoms that previously didn't respond to treatment. However, you should only do this if instructed to by the doctor in charge of your care.

A newer type of antihistamine called rupatadine has proved effective in treating more severe cases of chronic urticaria that do not respond to other antihistamines.

The doctor in charge of your care should be able to tell you if you could benefit from taking rupatadine.

Menthol cream

Menthol cream can be used as an alternative or in addition to antihistamines as it has been shown to relieve itchiness. Your GP can prescribe this.

Corticosteroid tablets

More serious episodes of urticaria can be treated with short doses of corticosteroid tablets, such as prednisolone. Possible side effects of corticosteroid tablets include increased appetite and weight gain, mood change, and difficulties sleeping (insomnia).

Long-term use of corticosteroids in chronic urticaria is not recommended for the reasons mentioned above.

H2 antihistamines

The type of antihistamines you can get from the pharmacist are known as H1 antihistamines.

But there are several other types of antihistamines, including H2 antihistamines.

These can be sometimes useful in treating chronic urticaria as they can narrow blood vessels. This in turn can often help reduce redness of the skin.

H2 antihistamines can be used in combination with H1 antihistamines or as an alternative to them.

Side effects of H2 antihistamines are uncommon but include:

If you feel dizzy after taking an H2 antihistamine, do not drive or use tools or machinery.

Narrowband ultraviolet B phototherapy

Narrowband ultraviolet B phototherapy (NUVB) is a type of treatment that involves exposing areas of your skin to high-energy ultraviolet light. The light can help clear an otherwise persistent area of rash.

NUVB involves standing in a chamber, much like a shower, that contains a number of fluorescent bulbs. Your skin is then exposed to the light for a short time, usually not more than a few minutes.

You would usually attend two to five sessions a week. Most people require 20 sessions before their symptoms significantly improve.

The light can cause some burning of the skin, similar to a mild sunburn. You can be given a cream to help soothe any burning.

Exposure to ultraviolet light carries a theoretical risk of causing skin cancer in later life.

It is unclear exactly how high that risk is as this is a relatively new treatment, but most experts think the risk should be small.

Leukotriene receptor antagonists

Leukotriene receptor antagonists are a type of medication that can often reduce redness and swelling of the skin.

They can be a useful long-term alternative to using corticosteroid tablets as they do not carry the same high risk of causing wide-ranging side effects.

Side effects are uncommon and relatively minor, such as headaches and feeling sick.

Cyclosporin

A powerful medication called cyclosporin has proved effective in treating urticaria in around two-thirds of cases.

Cyclosporin works in the same way as corticosteroids do. It suppresses the harmful effects of the immune system and is available in capsule form or as a liquid that you drink.

Common side effects of cyclosporin include:

The longer a person takes cyclosporin, the less effective it tends to become. One study found that only one person in four was still free of symptoms after taking the medication for five months.

Side effects such as high blood pressure and high cholesterol are also a cause for concern as these can increase your risk of heart disease and stroke.

Even if you still respond to treatment, it may be recommended that the medication is withdrawn after a few months.

Diet

There is controversy over the role of diet in people with long-term hives. There are two groups of chemicals in foods that may trigger urticaria in some people: vasoactive amines and salicylates.

Avoiding or reducing the intake of these chemicals may improve the symptoms.

You may wish to keep a food diary to see if avoiding a certain food helps your symptoms. If you restrict your diet, consult a dietitian, who can make sure that you are not avoiding foods unnecessarily and that your diet is adequate.

Vasoactive amines

Foods that contain vasoactive amines, or cause histamine release, include:

  • shellfish
  • strawberries
  • tomatoes
  • fish
  • chocolate
  • pineapple

Salicylates

Salicylates are naturally occurring aspirin-like compounds that are found in a wide variety of foods of plant origin. You can try cutting down on these, but do not completely avoid them. Foods that contain salicylates include:

  • tomatoes
  • spices
  • orange juice
  • raspberries
  • tea

For more information on following a low-histamine diet, see Allergy UK: histamine intolerance.

Avoiding triggers

If you know what triggers your urticaria or makes it worse, avoiding the trigger may keep your condition under control.

Triggers such as alcohol and caffeine can be easily avoided. And if you think a particular medication may be triggering your symptoms, contact the doctor who prescribed it as alternatives may be available.

Avoiding stress can be harder, particularly if your symptoms negatively affect your quality of life.

If you have chronic urticaria, you may find that relaxation techniques, such as meditation or hypnosis, reduce your stress levels and the severity of your symptoms.

Read about stress management.

Page last reviewed: 01/05/2012

Next review due: 01/05/2014

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