Acute Hives Treatment

Acute hives are treated with the goal of quickly calming itch, reducing swelling, and limiting progression. Treatment depends on how extensive the rash is, how uncomfortable the symptoms are, and whether there are signs of a more significant allergic reaction.

Oral Antihistamines

For many patients, oral antihistamines are the foundation of acute hives treatment. These medications work by blocking histamine signaling, which helps reduce itching, redness, and raised welts. Non-sedating antihistamines are commonly used during the day, while more sedating options may sometimes be helpful at night when itching is interfering with sleep.

Short Courses of Oral Corticosteroids

When hives are more severe, widespread, or not adequately improving with antihistamines alone, a short course of oral corticosteroids may be used to rapidly decrease inflammation. These medications can be helpful in getting an acute flare under control, but they are generally used for short-term rescue rather than long-term management.

Acute hives may be triggered by infections, medications, foods, heat, pressure, or other exposures. Identifying and avoiding a clear trigger can be an important part of treatment when one is present. Cooling the skin, wearing loose clothing, and avoiding overheating may also help reduce discomfort during a flare.

Hives can sometimes occur with angioedema, a deeper form of swelling that commonly affects the lips, eyelids, face, and sometimes the tongue or throat. Mild swelling may improve with antihistamines, cool compresses, and supportive care. However, swelling involving the tongue or throat, breathing difficulty, or other signs of a severe allergic reaction may require immediate treatment with an EpiPen or other epinephrine auto-injector and urgent emergency care.