Hives and Angioedema (cont.)
Medications for Hives and Angioedema
- Short-acting type H1 antihistamines: These medications, including diphenhydramine (Benadryl), are the primary treatment of mild cases of hives and angioedema. These are available without a prescription and are inexpensive. However, they must be taken every six to 12 hours and cause sleepiness, which can interfere with normal activity.
- Long-acting H1 antihistamines: These may also be used for mild cases of hives and angioedema. These drugs, which include loratadine (Claritin) and cetirizine (Zyrtec), are also available without a prescription. They need to be taken only every 12-24 hours and usually do not cause disruptive sleepiness.
- Prescription antihistamines may also be recommended by a doctor. These include hydroxyzine (Atarax, Vistaril) and cyproheptadine, both of which tend to cause drowsiness. Levocetirizine (Xyzal) is an antihistamine available by prescription that cause less drowsiness.
- Type H2 antihistamines: Drugs such as ranitidine (Zantac), cimetidine (Tagamet), and famotidine (Pepcid) have also been found to improve the rash and swelling when given with the type H1 antihistamines. Type H2 antihistamines were developed to treat ulcers. The U.S. Food and Drug Administration (FDA) has not approved treating hives or angioedema with these drugs, but most physicians feel this is an appropriate use. Type H1 and H2 antihistamines may also be given together if necessary.
- Corticosteroids may be given over the short term in some situations. These drugs suppress the allergic response of the immune system. They may be given by injection or by mouth. Examples are prednisone (Deltasone), methylprednisolone (Medrol), and dexamethasone (Decadron). They reduce the chance of the rash coming back. They also relieve symptoms, such as swelling and inflammation, but may take a few hours to work. For severe situations, corticosteroids may be given by an injection or infused through an IV line.
- H1- and H2-blocking drugs: Hives that do not respond to type H1 and H2 antihistamines may be treated with another type of drug. An example is doxepin (Sinequan). These drugs are intended as antidepressants, but they also have strong antihistamine effects, blocking both H1 and H2 histamine reactions. They can be very sedating. The FDA has not approved treating hives with these drugs, but many physicians feel this is an appropriate use.
- In March 2104 the U.S. FDA approved the monoclonal antibody omalizumab (Xolair) for treatment of chronic idiopathic urticaria (CIU) in adults and children aged 12 years or older for whom H1 antihistamine treatment does not relieve symptoms. It is a monoclonal antibody that selectively binds to immunoglobulin E (IgE) on mast cells and basophils, preventing other substances from binding to the IgE receptors on these cells and thereby inhibiting the allergic response. Omalizumab is administered as a subcutaneous injection.
- For some patients who do not have relief with antihistamines or oral medications, topical medications like 5% doxepin cream (Zonalon) or capsaicin may be used.
Severe hives and most cases of angioedema may require more intense treatment.
- Epinephrine is a prescription drug, usually injected or given intravenously, that rapidly reverses the most severe allergic reactions, including anaphylactic shock.
- IV fluids, usually saline solution, are given to increase blood pressure.
- Oxygen may be given through a tube in the nose or via face mask in case of breathing trouble.
- Other medications may be given as needed to reverse symptoms or raise blood pressure.
- People who have angioedema usually need hospitalization as the recurrence risk is high, even with improvement after the initial treatment. Some cases of severe hives may also require hospitalization.
Medically Reviewed by a Doctor on 6/22/2015
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