the goal of treating most cases of ordinary urticaria is to relieve symptoms while the condition goes away by itself. the most commonly used oral treatments are antihistamines which help oppose the effects of the histamine leaked by mast cells. the main side effect of antihistamines is drowsiness. many antihistamines are available without prescription such as diphenhydramine (benadryl) taken in doses of 25 milligrams and chlorpheniramine (chlor-trimeton) taken in a dose of 4 milligrams. these can be taken up to three times a day but because these medications can cause drowsiness they are often taken at bedtime. those who take them should be especially careful and be sure they are fully alert before driving or participating in other activities requiring mental concentration. loratadine (claritin 10 milligrams) is an antihistamine available over the counter that is less likely to cause drowsiness. also approved for over-the-counter use is hydroxyzine (atarax vistaril) which causes drowsiness and its breakdown product cetirizine (zyrtec 10 milligrams) which is mildly sedating. antihistamines that require a prescription include cyproheptadine (periactin) which tends to cause drowsiness. prescription antihistamines that cause little sedation are fexofenadine (allegra) and levocetirizine (xyzal). sometimes physicians combine these with other types of antihistamines called h2 blockers such as ranitidine (zantac) and cimetidine (tagamet). this antihistamine list is not exhaustive. physicians individualize treatment plans to suit specific patients and modify them depending on the clinical response. oral steroids (prednisone [medrol]) can help severe cases of hives in the short term but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. other treatments have been used for urticaria as well including montelukast (singulair) ultraviolet radiation antifungal antibiotics agents that suppress the immune system and tricyclic antidepressants (amitriptyline [elavil endep] nortriptyline [pamelor aventyl] doxepin [sinequan adapin]). evidence to support the benefit of such treatments is sparse. in ordinary cases they are rarely needed. topical therapies for hives are available but are generally ineffective. they include creams and lotions which help numb nerve endings and reduce itching. some ingredients which can accomplish this are camphor menthol diphenhydramine and pramoxine. many of these topical preparations require no prescription. cortisone-containing creams (steroids) even strong ones requiring a prescription are not very helpful in controlling the itch of hives.
what is the treatment for hives?