Medical guideline-based management of hives begins with scheduled antihistamines like loratadine (10 mg daily), cetirizine (5–10 mg daily), or fexofenadine (180 mg daily) to block histamine activity and reduce inflammation. Avoid triggers, including stress and NSAIDs, while monitoring symptoms. For severe or persistent cases, prescription options like glucocorticoids or biologic immunomodulatory drugs may be considered.
January 9, 2025

Hives (Urticaria) Treatment

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Symptomatic management is recommended for hives, in addition to avoidance of identified triggers and nonspecific triggers such as stress and NSAIDs. Approximately 60% of hives cases resolve within 1 week.

All first-line recommendations are antihistamines, which block the actions of the pro-inflammatory chemical histamine. Use should be scheduled rather than on demand until hives resolve. 

First-line recommendations (antihistamines):

  • Loratadine: Adults and children ≥ 6 years: loratadine 10 mg orally once daily. Non-sedative but may be less effective in some patients than cetirizine. Loratadine 10 mg dissolving tablets (FDA NDA 20704/S-009).

  • Cetirizine: Adults and children ≥ 6 years: cetirizine 5–10 mg orally once daily. Rapid onset and highly effective but associated with higher sedating potential. Cetirizine 10 mg dissolving tablets (FDA NDA 22155).

  • Fexofendadine: Adults and children ≥ 12 years: fexofenadine 180 mg orally once daily. Effective and non-sedating but typically available only in traditional pill form. Fexofendadine 180 mg tablets (NDA 21909/S-003). 

Prescription medications:

  • Glucocorticoids: steroid medications with immunosuppressive effects

  • Biologic immunomodulatory drugs

Citations:

Bernstein, J. A., Lang, D. M., Khan, D. A., Craig, T., Dreyfus, D., Hsieh, F., ... & Wallace, D. (2014). The diagnosis and management of acute and chronic urticaria: 2014 update. Journal of Allergy and Clinical Immunology, 133(5), 1270-1277.

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