By Dr Ananya Mandal, MD
Hives or urticaria mostly resolves on its own and does not require treatment if the condition is mild. Acute urticaria usually resolves completely within six weeks. If the itching and symptoms are particularly bothersome, treatment may be offered.
Outline of treatment for urticaria
Itching, redness and raised red rashes are common symptoms of hives and result from the release of histamine from cells in the skin. Antihistaminic medications are available over the counter at pharmacies and may help relieve itching and redness. Some such drugs include levocetirizine, fexofenadine and loratadine and they work by blocking the H1 subtype of the histamine receptor that causes allergic reaction. Traditional antihistaminics could cause drowsiness but newer agents do not tend to cause this adverse effect, although some individuals may still experience drowsiness, particularly if they are taken in combination with alcohol. People who find that itchiness is interfering with their sleep may view drowsiness as a benefit and prefer to take chlorpheniramine or hydroxyzine, for example.
One of the most important treatment approaches is to avoid the factor that triggers urticaria. Such triggers can be identified through an examination of a patient's symptoms and a skin prick test to confirm a reaction to a suspected allergen. Avoiding stress may also help reduce the frequency and severity of hives.
Long term, persistent cases
In cases where the itching and rashes do not resolve, a corticosteroid such as predisolone may be prescribed. Corticosteroids are anti-inflammatory agents that can reduce symptoms and they are usually prescribed if the symptoms still persist after two weeks. A course of corticosteroids usually lasts for about three to five days.
In cases where hives last for over six weeks, narrowband ultraviolet B phototherapy may be prescribed, in which affected skin is treated with a special light source for a few minutes, two to five times a week for up to 20 sessions. Long-term urticaria may also be treated with leukotriene receptor antagonists such as monteleukast and zafirleukast which prevent histamine release. Drugs of this class need to be taken over a long period of time and are preventive rather than curative. Cyclosporin is an immunosuppressant that may be useful in very severe cases.
Reviewed by Sally Robertson, BSc