Treatment - OTCs

Reviewed by: HU Medical Review Board | Last reviewed: November 2022

The goal of treatment for chronic hives is to reduce the red, itchy bumps on your skin. Treatment usually includes medicines and lifestyle changes. While there is no cure for chronic hives, treatments can improve quality of life by reducing symptoms.1,2

Treatment usually includes medicines and lifestyle changes. Doctors start treatment for chronic hives with over-the-counter (OTC) drugs. These are drugs that can be purchased without a prescription. They are regulated by the U.S. Food and Drug Administration (FDA).3

OTC antihistamines and H2 blockers are often effective at treating chronic hives. Other OTC options may briefly soothe itchiness. These include skin creams and natural remedies for the skin. However, these will not treat symptoms long-term.1,2

Over-the-counter antihistamines

Oral antihistamines are the most effective treatment for chronic hives. They work by blocking the activity of histamine. Histamine is released by certain immune cells and causes allergy-like symptoms. For most people with hives, OTC antihistamines are enough to control symptoms.1,2

Older types of antihistamines cause drowsiness. For example, diphenhydramine (Benadryl®) can reduce symptoms but will cause drowsiness. Newer types are non-drowsy and can work for 24 hours. Examples of OTC antihistamines include:2

  • Fexofenadine (Allegra®)
  • Loratadine (Claritin®)
  • Levocetirizine (Xyzal®)
  • Cetirizine (Zyrtec®)

Some side effects of antihistamines are possible, including:2

  • Dizziness
  • Dry mouth
  • Nausea or constipation
  • Coughing

Sometimes, OTC antihistamines are not strong enough to control symptoms. In this case, you may need prescription antihistamines or other prescription drugs.1,2

Over-the-counter H2 blockers

Oral H2 blockers are another treatment option for chronic hives. They are sometimes combined with antihistamines. They work by narrowing blood vessels in the skin. This helps reduce inflammation and swelling. OTC versions of H2 blockers include:1,2

  • Cimetidine (Tagamet®)
  • Famotidine (Pepcid®)

Some side effects of H2 blockers are possible, including:2

  • Headache
  • Dizziness
  • Diarrhea
  • Muscle and joint pain

Skin creams

Doctors generally do not recommend OTC hydrocortisone creams, such as Cortizone, for chronic hives. That is because they generally do not provide long-term relief. However, many people with chronic hives often try these anyway.4,5

OTC skin creams may slightly improve symptoms. They can reduce inflammation and treat skin rashes. Drug-store versions go up to 1 percent hydrocortisone. Higher concentrations require a prescription. Hydrocortisone creams used long-term may cause a reaction.4,5

Anti-itch lotions and creams may provide temporary relief. However, these drugs will not make hives or swelling go away any faster. Some anti-itch remedies include:1,4

  • Calamine lotion, which often treats mild itchiness from sunburn, bites, and poison ivy
  • Aqueous creams that contain menthol
  • Diphenhydramine (Benadryl) in cream form
  • Moisturizers to prevent dry skin

Natural or herbal remedies

Natural remedies involve the use of plant-based medicines to provide symptom relief. There is not much evidence that these remedies work for chronic hives. The FDA does not regulate natural remedies.6

Certain natural remedies may briefly cool or soften your skin. Some OTC natural remedies used by those with chronic hives include:6

  • Adding baking soda to a bath
  • Vinegar and water applied with a cotton ball
  • Aloe vera gels or creams to cool the itch
  • Colloidal oatmeal as a lotion or a bath additive
  • Witch hazel, which acts as an astringent

Talk to your doctor before trying any natural remedies. Some medicines worsen symptoms instead of improving them. Your doctor may suggest that you first try products on unaffected skin. If you do not have any irritation, they should be safe to apply to hives.4

Some natural remedies can interact with other medicines you are taking. Before beginning treatment for chronic hives, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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