Medicines for Urticaria (hives)

What it is

Urticaria, commonly called hives or nettle rash, is an itchy rash of raised weals (bumps) or red or skin-coloured patches that can appear anywhere on the body and often move around, with individual weals typically fading within a day. It happens when cells in the skin release histamine and other chemicals, making small blood vessels leak fluid. Sometimes deeper swelling occurs, often around the eyes and lips (angioedema). Acute urticaria comes on suddenly and settles within a few weeks, frequently triggered by an infection, a food, a medicine, an insect sting or physical factors such as heat, cold or pressure. Chronic urticaria lasts longer (weeks to months or more) and often has no identifiable trigger, sometimes relating to the immune system. While it is uncomfortable and can affect sleep and confidence, urticaria itself is usually not dangerous; the main concern is when it is part of a severe allergic reaction. Diagnosis is usually clinical, with tests reserved for when an underlying cause or trigger is suspected.

How it is treated

The first step is to identify and avoid any obvious trigger, where one can be found. For the rash and itch themselves, treatment aims to block the effect of histamine, and non-drowsy antihistamines are the mainstay, used regularly while the urticaria is active rather than only when weals appear. If symptoms are not controlled, the antihistamine approach can be intensified before considering specialist options. A short course of a corticosteroid is sometimes used to settle a severe acute flare, but these are not suitable for ongoing control. Chronic urticaria that does not respond to antihistamines may be referred to a specialist for additional treatments. Throughout, the focus is on relieving symptoms, protecting sleep and quality of life, and recognising the rare situation where hives are part of a serious allergic reaction needing emergency care.