How to Treat and Get Rid of Hives - Everyday Health

If you have only one outbreak of hives and you don't have breathing difficulties, you probably don't need medical attention. Yet if you continue to get multiple bouts of hives that continue after a couple of weeks, you may want to call a doctor, Elmariah suggests. "Most often, the hives will resolve during this time or you'll figure out what's causing them."

But hives that continue for weeks warrant a trip to the dermatologist. If they continue for six weeks or longer they're considered chronic hives, which tend to be caused by the same triggers as short-term or acute cases of hives. "Because dermatologists are skilled at working with hives, they're your best bet in getting the appropriate treatment," Dr. Rossi explains.

How Doctors Diagnose Hives

Expect to undergo a thorough physical exam. The dermatologist will also likely ask you to review your hives experience in detail, including when the hives started, if you suspect anything in particular triggered your hives, what medications you've tried, and what type of response you've gotten. Come prepared with this information.

Doctors will also verify that the bump (or bumps) is hives, often circling the spot on your skin to see if it disappears the next day (if so, it's a hive, Elmariah says).

Once they've confirmed that it is hives, they'll work to determine the trigger. Rossi says: "Figuring out the cause can be the most frustrating part of it, especially if the tests aren't helpful."

You may require additional testing. If an allergy is suspected, you may need to undergo allergy testing. If you are diagnosed with a severe allergy, the doctor may prescribe an epinephrine auto-injector (such as an EpiPen) in case you're accidentally exposed to your allergen. (1)

And because chronic hives can signal autoimmune disorders, you may need to have a blood draw in which doctors will look for a common antibody found in many autoimmune disorders. In rare cases when a bout of hives doesn't disappear within 24 hours, your doctor may do a skin biopsy to see if there's inflammation of the blood vessels, Rossi adds.

Treatments Doctors Use for Hives

Doctors usually prescribe antihistamines as a first course of treatment for hives. Acute cases can generally be treated with over-the-counter antihistamines like Benadryl, Claritin (loratadine), Allegra (fexofenadine), and Zyrtec (cetirizine).

If your hives are persisting (or you've already tried OTC antihistamines without success), your doctor may move to another class of antihistamines called H2 antihistamines, including Tagamet (cimetidine), Pepcid (famotidine), and Zantac (ranitidine) (all require a prescription); up the dose of antihistamines (some as high as four times); or combine several antihistamines, Friedman says.

In some cases, your doctor may prescribe an oral steroid, such as prednisone, if your hives still aren't responding. Oral steroids are stronger, but can cause more significant side effects than antihistamines. (3)

If you're still not seeing results, your doctor may recommend even stronger medications, like an injectable prescription medication called omalizumab (Zolair). There's also evidence that some off-label drugs like cyclosporine (Restasis), light therapies like narrowband UVB phototherapy, and vitamin D supplementation can help. Some studies, including one published in the April 2014 issue of the Annals of Allergy, Asthma & Immunology, have shown that 4,000 international units of vitamin D a day is effective, Friedman says. (4)

It's important to note that you shouldn't try taking high doses of vitamin D or any other off-label medication on your own without instruction from your doctor. No one treatment works for everyone, Friedman says. And for some, such therapies may not be safe.

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