Hives (Urticaria) and Swelling (Angiodema): Management and Treatment

How are hives (urticaria) and swelling (angioedema) managed or treated?

Most of the time, hives and swelling go away without treatment. Your healthcare provider might recommend medications and at-home care to help you feel better and lower your chances of having hives again. Treatments include:

• Allergy medications: Medicines called antihistamines block histamine’s effects on your body. Antihistamines relieve itching from hives and prevent allergic reactions. Some antihistamines react fast, like diphenhydramine (Benadryl®). Depending how severe the hives are, your healthcare provider may recommend daily over-the-counter (OTC) or prescription allergy medications, like loratadine (Claritin®). fexofenadine (Allegra®), cetirizine (Zyrtec®) or levocetirizine (Xyzal®).
• Allergy shots: For hard-to-treat chronic hives, your healthcare provider may recommend a monthly injection of a drug called omalizumab (Xolair®). This medication blocks the body’s allergy antibody, immunoglobin E (IgE), from causing allergy reactions. People with severe allergies can make too much IgE, leading to problems like hives and asthma.
• At-home treatments: To relieve hives, you can take a cool bath or shower, wear loose-fitting clothing and apply cold compresses. An OTC hydrocortisone cream, such as Cortizone®, can relieve itching and swelling.
• Epinephrine: Severe allergic reactions and swelling can lead to a life-threatening condition called anaphylaxis. Symptoms include hives, swelling, shortness of breath, wheezing, vomiting and low blood pressure. People experiencing anaphylaxis need an immediate epinephrine injection (EpiPen®) to open a swollen airway.
• Oral steroids: Corticosteroids, such as prednisone, can relieve hive symptoms that don’t respond to antihistamines.

What are the complications of hives (urticaria) and swelling (angioedema)?

Anyone who has a severe allergic reaction could have life-threatening swelling (angioedema) of the airways — your throat and lungs. This condition is known as anaphylaxis. It can potentially close off the airways, resulting in death.

Anaphylaxis is often triggered by a severe allergic reaction to a certain food, like peanuts and tree nuts, or a bee sting. People having anaphylaxis need an immediate shot of epinephrine, such as injectable epinephrine (EpiPen® or AUVI-Q®). Epinephrine opens airways, raises blood pressure and reduces hives and swelling. If epinephrine is used outside of the medical setting, a trip to the ER is warranted, since symptoms can return if epinephrine wears off.