What Is Chronic Idiopathic Urticaria (Hives)? Symptoms, Causes, Diagnosis, Treatment, and Prevention - Everyday Health

Medication Options

Part of the decision to treat or not treat chronic hives largely depends on the patient, says Aronica. "If I have a patient who is having intermittent hives — they're getting an outbreak once a week or a couple times a month — taking a medication every single day for this may not be the appropriate strategy. That decision can depend on how the hives are affecting them and what they want to accomplish," he says.

For acute hives and localized urticaria, some patients find relief with topical steroids, but that's not recommended for chronic hives lasting six weeks or longer, says Aronica. "Topical steroid cream shouldn't be used for longer than two weeks because it can damage and thin the skin," he says.

Additionally, many patients with chronic urticaria have outbreaks in multiple places on their body. "If you use a topical steroid over large portions of your skin there is some systemic absorption, and that can cause unwanted side effects," says Aronica.

The first-line therapy for patients who are having frequent episodes of chronic hives is a long-acting, nonsedating antihistamine. Many of these medications are available over the counter.

These medications include Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Clarinex (desloratadine), and Xyzal (levocetirizine). Successfully managing chronic hives often requires a dose higher than the one printed on the package. Don't try to figure that out on your own; your provider will recommend the appropriate dose, says Aronica.

If these medications aren't effective, doctors may opt to add or substitute another drug. These include:

Histamine (H2) blockers These medications, also called H2 receptor antagonists, are injected or taken orally. Examples include Tagamet HB (cimetidine) and Pepcid (famotidine).

Anti-inflammation medications Oral corticosteroids, such as prednisone, can help with symptoms such swelling, discoloration, and itching, but shouldn't be used long-term.

Asthma drugs with antihistamines These medications can help with itching and hives in some people when used together with antihistamines. Examples are Singulair (montelukast) and Accolate (zafirlukast).

Monoclonal antibodies The drug Xolair (omalizumab) may be used for a type of difficult-to-treat chronic hives. It's an injectable medicine usually given once a month.

Immune-suppressing drugs These include cyclosporine, methotrexate, and tacrolimus and are usually limited to short-term use.

Diet Options

Some patients with chronic urticaria opt to follow a low-histamine diet, says Aronica. "I tell them if that helps them, that's fine with me. The data is a little mixed, but it is something our guidelines suggest people can try," he says.

A low-histamine diet is one that avoids or limits foods have higher levels of histamine, such as seafood, fermented foods (aged cheeses, dry sausage, fermented soy), tomatoes, eggplant, spinach, and avocado.

In a study of 56 people with chronic urticaria and gastrointestinal symptoms, 75 percent of participants benefited from the low-histamine diet.

Once the symptoms improve, the person doesn't necessarily have to continue avoiding those foods, notes Aronica.

Alternative and Complementary Therapies

Vitamin D "There is some evidence that there may be slightly higher risk of chronic urticaria in people with vitamin D deficiency. In some cases, if you address the deficiency, the hives may improve," says Aronica.

Researchers at the University of Nebraska found that people with chronic hives who took 4,000 IU of vitamin D3 had significant improvement in their hives at the end of three months.

It's possible to take too much vitamin D — it can be toxic in high doses — so make sure you talk to your healthcare provider about it.