Urticaria medication primarily consists of allergy medicine like antihistamines and corticosteroids that help relieve symptoms of urticaria like swelling, itchiness, and a burning sensation of the skin.
In addition, home remedies like taking an oatmeal bath or applying a chamomile compress can be used to complement the use of these medications.
Urticaria medication should only be used as indicated by a dermatologist or your primary care provider, who will prescribe the best treatment based on age, cause, and pregnancy status.
Severe cases of urticaria with symptoms like swelling of the mouth, tongue, or throat or difficulty breathing require immediate medical attention at the emergency department to prevent potentially life-threatening consequences. In these cases, urticaria medications are typically given through an IV or directly into the muscle.
Primary medications
In general, the first line treatment for urticaria (hives) is antihistamines, however in some cases it may be necessary to use other medications in combination or in place of antihistamines, such as immunosuppressants.
1. Antihistamines
Antihistamines are allergy medications that help relieve symptoms like itchiness, redness, or swelling of the skin caused by acute or chronic urticaria. They work by blocking the action of histamine, which is a substance produced by the body that mediates the allergic response.
Common antihistamines that might be prescribed by your healthcare provider include:
- Loratadine tablets or syrup (Claritin);
- Desloratadine tablets (Clarinex);
- Fexofenadine tablets or oral suspension (Allegra);
- Cetirizine tablets, syrup, or injectable solution (Zyrtec);
- Levocetirizine tablets or oral solution (Xyzal).
Antihistamines are the most prescribed urticaria medications because they have fewer side effects than other treatments. They should not be given to children unless recommended by a pediatrician. Make sure to tell your healthcare provider if you are pregnant or breastfeeding before taking antihistamines.
Your provider may recommend other antihistamines like diphenhydramine and hydroxyzine, which are more effective and rapid-acting than the antihistamines listed above, however they also come with more potential side effects, such as sedation, somnolence, dizziness, confusion, and decreased concentration.
A different class of antihistamines called H2 antihistamines, which include medications like cimetidine and famotidine, may be added if treatment with the above antihistamines alone is not enough to relieve urticaria symptoms. This is especially true in the case of acute urticaria. Antidepressives like doxepin may also be prescribed in the case of chronic urticaria.
2. Corticosteroids
Corticosteroids are medications that are often used to treat pressure urticaria, urticarial vasculitis, and chronic urticaria when other treatments have failed or in cases of significant discomfort.
The most commonly prescribed corticosteroids are:
- Prednisone tablets (Deltasone);
- Prednisolone tablets or oral solution (Millipred or Flo-Pred).
These corticosteroids should only be taken under the supervision of your doctor or primary care provider, who will determine the correct dose and duration of treatment based on indication.
In the case of severe acute urticaria, with symptoms like swelling of the mouth, tongue, or throat or difficulty breathing, corticosteroids may also be given as an injection in the hospital emergency department.
3. Immunosuppressants
Immunosuppressants are medications that weaken the immune system and can help relieve symptoms of idiopathic urticaria and severe chronic autoimmune urticaria, such as bumps, redness, and itchiness of the skin.
These medications include:
- Cyclosporine capsules, oral solution, and injectable solution (Neoral and Sandimmune);
- Tacrolimus capsules, tablets, granules for suspension, and injectable solution (Prograf).
These medications are generally indicated when treatment with antihistamines is not effective and/or when the necessary dose of corticosteroids is very high. They should only be used as directed by a doctor.
4. Other medications
In some cases, your healthcare provider may recommend adding other medications like:
- Montelukast (Singulair): a substance with a different mechanism of action than antihistamines that also reduces allergy symptoms;
- Hydroxychloroquine (Plaquenil) or colchicine (Colcrys): can be added after use of hydroxyzine and before (or in combination with) systemic steroids in the treatment of persistent urticarial vasculitis;
- Omalizumab (Xolair):a type of monoclonal anti-IgE antibody indicated for the treatment of chronic urticaria triggered by the activation of mast cells and basal cells by an auto-antibody.
It is important to talk to your healthcare provider before starting any medication to determine which form of treatment is right for you.
Home remedies
Especially in mild cases, taking an oatmeal or lavender bath is a great way to complement the use of other treatments prescribed by your doctor. You can also try applying a chamomile compress to the affected area.
These natural remedies should not be used in place of medications prescribed by your healthcare provider, and only serve as a way to provide more rapid relief from symptoms.
Other natural ways that can help relieve symptoms of urticaria include: wearing lightweight, comfortable, and loose clothing (preferably cotton); avoiding harsh soaps and opting for gentler soaps with a neutral pH; applying mineral sunscreen before leaving the house; and avoiding scratching your skin.