Hives are raised crimson welts or splotches that are usually itchy, tender, and swollen. They’ll come up abruptly and type wherever in your physique.
In lots of instances, over-the-counter antihistamines (often known as H1 antihistamines) are usually sufficient to supply reduction, says Nicole Weiler, MD, a dermatologist and medical assistant professor of dermatology at NYU Langone Well being in New York Metropolis. These drugs block histamine, a chemical sign launched in your physique as a response to irritation, which can be prompted by publicity to an allergen (like meals or pollen) or to an an infection (like a virus).
However even when antihistamines are working at first, they might cease working for hives. That’s while you’ll doubtless have to strive a special choice.
“Though over-the-counter antihistamines can normally be sufficient to supply reduction, the exercise of hives can wax and wane, which suggests antihistamines could also be kind of efficient at totally different instances,” says Dr. Weiler. “When it turns into much less efficient, there are different decisions in stepping up remedy.”
Listed here are 4 choices your physician may suggest in case your antihistamines cease working for you.
1. H2 Blockers
When over-the-counter drugs — comparable to cetirizine (Zyrtec Allergy), fexofenadine (Allegra Hives), levocetirizine (Xyzal Allergy 24HR), and loratadine (Claritin) — don’t work effectively for you, your physician could prescribe a medicine referred to as an H2 blocker, or H2 antihistamine. Generally prescribed for sure gastrointestinal points, these medication work by concentrating on histamine receptors within the abdomen and blood vessels. That may convey down swelling and redness.
Choices embrace:
cimetidine
famotidine
nizatidine
Your physician could have you ever strive one in all these medication along with an over-the-counter antihistamine. The mixture might be very efficient, says Brendan Camp, MD, a dermatologist at MDCS Dermatology in New York.
If that sort of multi-medication method additionally doesn’t give you the results you want, you then’d doubtless be taken off antihistamines altogether to strive a special technique, he says.
2. Corticosteroids
Oral corticosteroids (additionally referred to as steroids or glucocorticoids) comparable to montelukast and prednisone might be the subsequent step if antihistamines aren’t working, Dr. Camp says.
These prescription drugs work by lowering irritation all through your physique. They’re just like cortisol, a hormone that your physique makes naturally. They’ll additionally relieve ache and briefly suppress the immune system so it stops releasing histamines.
However steroids aren’t a long-term remedy. They’ll solely be used to alleviate a hives-related rash when it’s acute (short-term) moderately than power (long-term). That’s as a result of the possibilities of getting unwanted effects — comparable to temper adjustments, muscle weak point, weight achieve, and abdomen irritation — enhance the longer you are taking them.
3. Biologics
A subsequent step in remedy is to contemplate biologic drugs, notably when hives turn out to be frequent or intense, and don’t reply to antihistamines or corticosteroids, says Amiirah Aujnarain, MD, an allergist, immunologist, and pediatrician at Kindercare Pediatrics in East York, Ontario, Canada.
“These drugs goal an antibody referred to as immunoglobulin E (IgE), which [is] launched by the immune system, normally when an allergen is detected,” she says. “This method should be carried out below a specialist’s care.”
About 30 % of power hives are linked with IgE. Biologics work by binding to this antibody and lowering its results — a course of that decreases the discharge of histamine as effectively.
One instance of a biologic that targets IgE known as omalizumab (Xolair), which alters the immune response to scale back signs.
In April 2025, the U.S. Meals and Drug Administration (FDA) accredited dupilumab (Dupixent) for the remedy of power hives (additionally referred to as power spontaneous urticaria) in individuals who nonetheless have signs regardless of remedy with H1 antihistamines. Dupixent targets inflammatory proteins within the physique referred to as interleukin (IL)-4 and IL-13, which additionally targets the eventual manufacturing of IgE.
4. Life-style Adjustments
Sure life-style adjustments may also help tackle hives, and so they can also play a task in stopping flare-ups of hives sooner or later.These embrace:
With the assistance of your physician, establish and keep away from any meals triggers that will immediate signs.
Scale back publicity to airborne allergens, like pet dander or pollen.
Use detergents and soaps with out scents or dyes, which might irritate your pores and skin.
Keep away from excessive temperature adjustments, which might immediate hives or worsen signs for some individuals.
Do your greatest to handle stress, which doesn’t straight trigger hives however could make them worse.
Put on loose-fitting, light-weight clothes to keep away from pores and skin irritation.
These life-style adjustments might be useful for lowering the frequency, length, and depth of hives. However they’re typically used as an addition to drugs, not as a alternative.
The Takeaway
Over-the-counter (H1) antihistamines are practically all the time the primary line of remedy for a hives rash, since these meds can block histamine, a chemical within the physique that prompts hives signs.
Prescription antihistamines, corticosteroids, and biologic drugs are the subsequent steps when over-the-counter choices aren’t working for you.
Some life-style adjustments could assist ease hives. However they’re typically used together with remedy moderately than instead of it.
When you’re getting more-frequent hives, and particularly in the event that they’re changing into worse and also you’re not getting reduction from over-the-counter antihistamines, discuss together with your physician about different choices that may assist.
