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.

Last reviewed by a Cleveland Clinic medical professional on 04/22/2020.

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