Officially known as urticaria, hives are a skin condition that causes small red, itchy bumps to form. Allergic reactions to medications or food can lead to hives, and insect bites are another common trigger. Less common causes of hives include colds and other infections, thyroid disease, and sun exposure. Occasionally, intense exercise can result in the formation of hives. Urticaria can affect individuals of any age, and the hives usually form within a few minutes after encountering a trigger. However, some individuals may notice hives forming two to three hours after exposure. Most cases generally resolve within six weeks, and sometimes hives may even resolve in as little as one day. Hives that do not go away within six weeks are considered chronic and may need specialist treatment. The treatments described below can aid in urticaria symptom relief and resolution.
Antihistamines are a common type of anti-itch medication. These anti-itch medications are usually the first line of treatment for mild or moderate cases of hives. Antihistamines, including loratadine, fexofenadine, cetirizine, and diphenhydramine, are widely available over the counter at pharmacies. For cases that do not respond to these medicines, stronger versions can be obtained from a doctor. Other antihistamines used for hives include levocabastine, desloratadine, and hydroxyzine.
Generally, antihistamines must be taken daily to alleviate symptoms. Drowsiness is the most common side effect of antihistamines, and some patients may also experience dizziness, dry mouth, or nausea. Antihistamines help stop the formation of hives and can be used for both acute and chronic forms of the condition. If antihistamines are not beneficial, prednisone and other corticosteroids can also be used to relieve itching. These medicines are only available through a doctor, and they can only be used for a short time due to side effects such as high blood pressure and weight gain.
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Anti-inflammatory medication can help patients who have hives that do not resolve with antihistamines. One of the most commonly recommended anti-inflammatory medications for these patients is dapsone, an antibiotic that alleviates swelling and redness. The drug is used orally or as cream applied to the skin. Side effects of dapsone include nausea, loss of appetite, a ringing sensation in the ears, headache, blurry vision, and difficulty sleeping. Rarely, the drug can lead to chest pain, muscle weakness, and fluctuations in mood, and thus, these side effects should be reported to a doctor. Dapsone can cause changes to some blood markers, and many physicians will want to monitor patients with blood tests every two weeks for the first phase of treatment. Other drugs known as leukotriene antagonists (or modifiers) also fight inflammation. These drugs are commonly used for asthma patients and stop the body from releasing leukotriene, a substance that restricts airflow for asthmatics and causes inflammation throughout the body. Zafirlukast and montelukast are two of the most widely used leukotriene antagonists, and they are typically used together with antihistamines. These drugs can cause headaches, difficulty sleeping, irritability, nausea, and vomiting.
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Doctors recommend immunosuppressants for patients who do not respond to other medications. While most cases of hives will not need them, immunosuppressants can be particularly helpful for patients who have a rare form of hives known as chronic idiopathic urticaria. With this condition, hives can be present for two to three years without relief, and no specific trigger can be identified. Currently, the immune-suppressing drug omalizumab is one of the most beneficial treatments for chronic hives. A doctor administers it through a subcutaneous injection just underneath the surface of the skin. Injections must be repeated every two to four weeks. Typically, the side effects of the medicine include nausea, coughing, headaches, joint pain, and swelling of the throat, sinuses, or nose. In rare cases, the drug may also cause inflammation of the blood vessels, fever, aching muscles, and heart problems. Any of these serious side effects should be reported immediately.
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In addition to medications, home remedies can help reduce swelling and pain, and these are particularly helpful for patients with acute or mild hives. Wearing loose clothing keeps fabric from touching the skin and can lessen pain. Using cold compresses or ice packs can also alleviate swelling and soothe the skin. Taking cool showers may also be useful for pain relief. Aloe vera gel is a common home remedy believed to have soothing effects for hives. In addition, some studies have suggested colloidal oatmeal can stop itching and reduce skin inflammation over small areas. Colloidal oatmeal is very finely milled oatmeal placed in a liquid or gel suspension. It is available in lotions and special formulations for bathing. Some experts believe complementary medicine therapies such as meditation, deep breathing exercises, and progressive muscle relaxation can help in alleviating the pain that may result from hives. For hives caused by food, medication, or insect bites, avoiding triggers is especially important to keep swelling and pain from increasing and to avoid the formation of new hives.
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Blood Protein Controllers
Blood protein controllers are another class of drugs that can be used for urticaria patients who cannot obtain relief of their symptoms with more conservative methods. For these patients, the antidepressant doxepin may be beneficial in relieving itching and pain. Doxepin must be obtained through a doctor and is known as a tricyclic antidepressant and helps to balance certain neurotransmitters in the brain. The drug can cause heartburn, constipation, eye pain or vision problems, stomach pain, fast heart rate or changes in heart rhythm, and problems with urination. Patients who take this medication need to be monitored frequently by their doctors and should report any concerns.