Urticaria (Hives) Treatment

Urticaria is a type of skin rash. It is also known as hives.

Urticaria can occur anywhere on the body and appears as raised, red welts that vary in size and are often itchy.

Types of urticaria

Urticaria can be acute (short term) or chronic (long term).

• Acute urticaria — is defined as urticaria that lasts for 6 weeks or less
• Chronic urticaria — is a less common type of urticaria that goes on for more than 6 weeks and often persists for months or years.
• Urticaria vasculitis — is a rare form of urticaria. It is caused by inflammation of the blood vessels causing damage to surrounding tissues and resulting in red patches, itching, burning and skin discolouration.

What causes urticaria?

Urticaria occurs when the body releases a substance called histamine into the blood, which can cause symptoms like redness, itching and swelling.

This can happen because of:

• an allergy to a food, substance, insect bite or sting
• infection
• medication
• a physical trigger such as friction from tight clothing, or exposure to heat or cold

The cause of chronic urticaria is unclear, but it may be an autoimmune disorder that occurs when the body mistakenly attacks its own tissues.

In some cases, urticaria has no obvious cause.

Anaphylaxis

Rarely, urticaria can be part of a severe allergic reaction called anaphylaxis which can be life-threatening.

Call an ambulance or go to A&E immediately if you have urticaria that is accompanied by:

• swelling of the face, lips, eyelids, tongue, and throat
• difficulty breathing or noisy breathing (wheezing)
• difficulty talking
• chest tightness
• feeling dizzy or faint
• collapse

Most cases of urticaria clear up without treatment within a few days.

If your symptoms are bothering you, your GP may prescribe or recommend medication to relieve symptoms like itching, redness or swelling. Treatments for urticaria include:

• Antihistamines

These work by blocking the histamines in your body that are causing your symptoms.

• Corticosteroids

These work by reducing the chemicals that trigger inflammation in the body. Prednisolone is a common corticosteroid used to treat severe urticaria.

If your urticaria is severe or doesn’t get better with treatment, your GP will refer you to a specialist skin doctor called a dermatologist for further tests and treatment.

How effective is urticaria treatment?

Antihistamines and corticosteroids are normally effective in treating the symptoms of acute urticaria.

Treatment for chronic urticaria is often more complex and usually focuses on managing symptoms and reducing exposure to possible triggers.

How long does it take for urticaria treatment to work?

Most antihistamines start to work within about 30 minutes of taking them.

Corticosteroid creams start to take effect as soon as you apply them.

Prednisolone tablets and liquid start to work within around 4 hours.

Can urticaria come back after treatment?

Urticaria is a symptom rather than a medical condition. Therefore, it is likely to come back if you come into contact with whatever triggered it in the first place.

It’s important to try to identify what triggered your urticaria and prevent or limit exposure to it in the future.

• Antihistamine tablets such as cetirizine and fexofenadine help relieve urticaria symptoms like itching. The usual dose of cetirizine is one 10mg tablet once a day and fexofenadine 180mg once a day. Both cetirizine and fexofenadine are non-drowsy antihistamines and are less likely to make you feel sleepy than some other antihistamine medications. You can buy many antihistamines over the counter from supermarkets or pharmacies.
• Oral corticosteroids like prednisolone are sometimes prescribed for severe urticaria. The usual dose is 40mg per day for 7 days. Corticosteroids aren’t normally recommended for long-term use as they can cause unpleasant or harmful side effects. Prednisolone is available on prescription only and comes as liquid or tablets.

Treatment for chronic urticaria

Treatments for chronic urticaria may include the above, or you might have more specialist treatment prescribed by a dermatologist:

• Leukotriene receptor antagonists

This may be prescribed as a long-term alternative to corticosteroids. They work by reducing inflammation.

• Cyclosporin

This reduces inflammation by suppressing the body’s immune response. Cyclosporine is effective in treating chronic urticaria but can cause potentially serious side effects, so may not be suitable for long-term use.

• Omalizumab (Xolair)

This is a relatively new medication that is given by injection once every 2 to 4 weeks. It works by blocking immunoglobulin E, one of the chemicals that causes symptoms of allergic reactions.

What’s the best treatment for urticaria?

The best treatment for your urticaria depends on the type of urticaria you have and several factors, such as your symptoms, what other treatments you have tried, your general health and any other medications you are taking.

Talk to your GP about which urticaria treatment may be best for you.

Like all medications, urticaria treatments can cause side effects in some people.

Most people don’t experience any side effects, or their side effects are mild and go away within a few days.

If your side effects are bothering you, getting worse or not going away, speak to your GP.

Always take your medication exactly as directed by a doctor, read the patient information leaflet carefully before starting your medication, and ask your doctor or pharmacist if you have any questions.

Antihistamines

Common side effects of fexofenadine include:

• nausea (feeling sick)
• headaches
• drowsiness (feeling sleepy)
• dizziness
• dry mouth

Serious side effects

It’s rare to have any serious side effects when taking fexofenadine.

Common side effects of cetirizine include:

• nausea (feeling sick)
• headaches
• drowsiness (feeling sleepy)
• dizziness
• dry mouth
• diarrhoea
• sore throat
• blocked or runny nose, sneezing

Serious side effects

It’s rare to have any serious side effects when taking cetirizine.

Corticosteroids

Common side effects of prednisolone include:

• indigestion
• restlessness
• difficulty sleeping
• weight gain
• excessive sweating
• mood changes

Serious side effects of prednisolone include:

• extreme thirst, peeing more than usual, confusion, drowsiness, fruity-smelling breath —these could be signs of high blood sugar
• puffy, rounded face, weight gain around your middle, severe headaches, and slow wound healing —these could indicate Cushing’s syndrome
• fever, chills, sore throat, cough, earache, mouth ulcers, pain when peeing, slow wound healing —may indicate an infection
• loss of appetite, vomiting, fainting, dizziness, muscle weakness, fatigue, mood changes, and weight loss — may be signs of adrenal gland problems
• Severe stomach or back pain, and vomiting — may indicate pancreatitis
• muscle pain, weakness, and changes to your heart rate — could be signs of low potassium levels
• shortness of breath
• changes in your vision
• swelling in your arms and legs
• abnormal bruising or bleeding
• black or red stools (poo)
• mood changes (may be severe)

Rarely, urticaria treatments can cause a serious allergic reaction called anaphylaxis.

Call an ambulance, or go to A&E immediately if you experience:

• difficulty breathing
• red, raised, itchy rash
• chest tightness
• swelling of the face, eyelids, tongue, or throat
• dizziness or fainting
• collapse

Some types of urticaria treatments may not be suitable for everyone. Always tell your doctor about any medical conditions or allergies you have and any other medications you are taking before starting treatment for urticaria.

Antihistamines

Talk to your GP or pharmacist before taking antihistamines if you:

• have ever had an allergic reaction to any medication
• are allergic to peanuts, soya, or some food additives
• have epilepsy or another seizure disorder
• have problems with your heart, liver, or kidneys
• have problems passing urine (peeing)
• are pregnant or breastfeeding

Prednisolone

Talk to your GP or pharmacist before taking prednisolone if you:

• have ever had an allergic reaction to any medication
• are pregnant, trying to get pregnant, or breastfeeding
• have any type of infection or unhealed wound
• have recently had, or are due to have any vaccinations
• have had recent contact with someone with chickenpox, shingles, or measles
• have a family or personal history of mental health problems
• have problems with your liver
• have diabetes
• have epilepsy
• have glaucoma
• have osteoporosis (brittle bones)
• have an underactive thyroid
• have ever had a stomach ulcer

If you have a red, raised itchy rash, and think you may have urticaria, make an appointment with your GP. This will ensure you get the correct diagnosis and any necessary treatment. 

Alternatively, you can get an online diagnosis with Superdrug Online Doctor’s Skin Diagnosis service. 

Simply upload a photo of an affected area of your skin, and one of our doctors will view it and provide a diagnosis, advice, and treatment within 24 hours.

Home remedies

Some things you can do yourself to help relieve symptoms of urticaria include:

• avoiding contact with known triggers
• using soaps, lotions, and cosmetics for sensitive skin
• staying out of the sun
• wearing loose-fitting clothes in breathable fabrics
• not scratching your rash
• applying cool compresses and soothing lotion

Acupuncture

Acupuncture has been suggested as a treatment for chronic urticaria. One review (1) of 6 previous clinical trials found a possible improvement in symptoms after treatment with acupuncture, but more research is needed.

Acute urticaria usually resolves without treatment, and medication is focused on helping to relieve its symptoms rather than ‘curing’ it.

If your urticaria lasts longer than 6 weeks, it is classed as chronic urticaria. 

There is currently no cure for chronic urticaria, and treatment focuses on managing symptoms with medications and reducing or alleviating triggers that cause or worsen the urticaria.