Hives: Diagnosis and treatment
When do hives require emergency care?
Go to urgent care or the nearest emergency room if hives cause any of the following:
Swelling on your face, inside your mouth, or in your throat
Problems swallowing or breathing
Feeling light-headed or faint
Racing heart
Swelling on your face, inside your mouth, or in your throat can cause problems breathing or swallowing, which can happen fast and require immediate medical care.
How can I treat hives at home?
If you have mild hives, you can often treat them at home. To get relief for mild hives, dermatologists recommend that you take an antihistamine (non-drowsy, 24-hour relief), and you can try these home remedies.
Mild hives look like one or both of the following:
Raised welts
Small patches
The welts and patches are often extremely itchy.
On darker skin tones, hives may be the same color as your surrounding skin, purple, gray, or dark brown. If you have a lighter skin tone, the welts and patches are red or pink.
Individual hives go away within 24 hours, but new ones can appear. Left untreated, hives may clear in a few days to a few weeks.
When should I see a dermatologist for hives?
It can be helpful to see a board-certified dermatologist when hives:
Last longer than 6 weeks
Cover a large area of your body
Dermatologists specialize in diagnosing and treating skin conditions, including hives.
Your dermatologist knows that some types of hives are caused by a trigger, such as pressure on your skin, cold, or sunlight. These are called inducible hives.
Another type of hives is called chronic spontaneous urticaria. This type of hives lasts for 6 weeks or longer, produces hives on most days of the week, and doesn’t have a known cause.
Your dermatologist knows how to rule out other conditions that can look like hives and how to create a treatment plan that can safely and effectively control hives. Sometimes, it’s not possible to determine the exact cause of hives, but your dermatologist can still help you treat them effectively.
How do dermatologists diagnose hives?
A dermatologist can often diagnose hives by looking at your skin.
Sometimes, dermatologists gently touch your skin with an object, such as a cotton-tipped applicator, to see if gently drawing on your skin will cause hives to develop.
While your dermatologist may diagnose you during your first office visit, finding the exact cause of hives can take time.
To diagnose hives, your dermatologist may also require one or more of the following medical tests:
Allergy tests (on the skin or blood test)
Blood work (to rule out an illness or infection)
Skin biopsy (remove a small bit of skin to help diagnose you)
How do I prepare for my dermatology appointment for hives?
To prepare for your first appointment about hives, be ready to answer the following questions:
How often do you get hives?
How long do the hives last?
Are the hives itchy or painful?
When you get hives, do you have other symptoms like feeling lightheaded or nauseous?
It can also be helpful to think about what you were doing a few hours before you developed hives. For example, try to remember what you were doing and answer the following questions:
What did you eat and drink, including red meat (e.g., beef, pork, veal, or lamb), gelatin, or dairy products?
Did you take medication or vitamin supplements, including those that you can buy without a prescription, such as ibuprofen or daily multivitamins?
Have you been feeling stressed?
Did a bug bite or sting you?
Were you outdoors in sunlight, cold, or heat?
Did you sweat a lot?
Were you wearing tight clothes or carrying a purse or backpack?
Have you had radiation therapy, a blood transfusion, or other medical treatments in the past year?
Tell your dermatologist if you develop hives hours after eating red meat (e.g., beef, pork, veal, or lamb), gelatin, or dairy products
Hives can be a sign of alpha-gal syndrome, a rare food allergy that can develop after being bitten by the Lone Star tick. This tick is found in many U.S. states.
While having answers to these questions is helpful, it’s important to know that the cause of hives cannot always be found. Even if the cause is unknown, your dermatologist can successfully treat hives.
How do dermatologists treat hives?
When treating hives, the goals are to:
Control the itch
Prevent new hives (existing hives go away on their own)
Avoid what’s causing the hives (when known)
Your dermatologist will tailor your treatment plan to the type of hives you have and your needs. For example, some of the medications described below have been approved by the U.S. Food and Drug Administration (FDA) to treat a type of hives called chronic spontaneous urticaria.
A treatment plan for hives may include one or more of the following:
Soothing anti-itch lotion or cream
To temporarily relieve the itch, your dermatologist may recommend one of the following, which you can buy without a prescription:
Pramoxine (anti-itch lotion)
Anti-itch cream containing menthol or calamine
Corticosteroids that you apply to your skin
When applied to the hives rash, this medication can help relieve the itch.
Antihistamine
This medication can help control the itch and swelling. Some antihistamines may also flatten hives, shorten how long you have hives, or reduce the number of hives you get.
Your dermatologist may recommend an antihistamine that you can buy without a prescription. Some patients need a stronger antihistamine and receive a prescription.
Two prescription antihistamines used to treat hives are desloratadine and hydroxyzine.
Desloratadine is FDA approved to treat a type of hives called chronic spontaneous urticaria. This antihistamine can relieve itch, reduce the number of hives, and decrease the size of hives. The FDA has approved this medication to treat chronic spontaneous urticaria in patients 6 months of age and older.
Hydroxyzine can relieve the itch but will often make you drowsy.
If the first antihistamine you take fails to work, your dermatologist may increase the dose or add another antihistamine to your treatment plan.
For an antihistamine to be effective, you must take it every day — and continue to take it every day until you’re no longer getting hives. At that time, your dermatologist will talk with you about reducing your dose until you stop for good.
Possible side effects of these antihistamines include headache, cough, and sore throat.
Brand names (prescription antihistamines): Clarinex (desloratadine) Vistaril (hydroxyzine)
What happens when antihistamines alone cannot clear hives?
Antihistamines often provide relief from hives. However, some patients need:
To continue taking an antihistamine and add another medication (sometimes another antihistamine) or therapy
A different medication or therapy
When this happens, your dermatologist may prescribe one or more of the following:
Light therapy
Also called phototherapy, this non-invasive treatment exposes your skin to a controlled amount of light. Exactly how phototherapy treats hives is still being studied. It may work on your immune system to reduce the itch and prevent new hives.
Many patients continue to take one or more antihistamines while receiving phototherapy.
If phototherapy is an option, you’ll need to go to a place that offers this therapy, such as your dermatologist’s office or a phototherapy treatment center. For this treatment to be effective, you’ll need phototherapy sessions a few (and possibly several) times a week for a few months.
Research suggests that patients who treat hives with both phototherapy and an antihistamine may stop getting hives for a longer amount of time than if they had only one type of treatment.
Possible side effects of phototherapy include sunburn-like discoloration that lasts about a day. When used for years, phototherapy can cause early skin aging and increase your risk of developing skin cancer.
Dupilumab
This medication works to control the inflammation that leads to hives. In clinical trials, it was shown to reduce the itch and number of hives.
The FDA has approved dupilumab to treat a type of hives called chronic spontaneous urticaria. Dupilumab is approved to treat chronic spontaneous urticaria in people 2 years of age and older who continue to get hives after taking antihistamines.
Dupilumab can take time to work. In clinical trials, results were noticed within 2 to 3 months.
While dupilumab can be an effective treatment, it doesn’t work for everyone.
If your dermatologist prescribes this medication, you may use it alone or along with an antihistamine.
You take dupilumab by injecting it under the skin. Before injecting yourself at home, you’ll be taught how to prepare and inject it.
Possible side effects include getting a cold, eye irritation, or developing a skin reaction where you inject.
Brand name: Dupixent
Omalizumab
This medication works throughout the body to calm your immune system, which can prevent your body from overreacting and producing hives.
The FDA has approved omalizumab to treat a type of hives called chronic spontaneous urticaria. It's approved to treat people 12 years of age and older who continue to get hives after taking antihistamines.
In clinical trials, omalizumab reduced the itch and number of hives. It can take time to work. Some people treat their hives for 4 to 6 months before they see their skin clear. While it can be an effective treatment for many people, omalizumab doesn’t work for everyone.
Your dermatologist may prescribe omalizumab alone to treat hives, or you may continue to take an antihistamine while using omalizumab.
If your dermatologist prescribes omalizumab, you will inject it just under your skin. Before injecting yourself at home, you’ll be taught how to prepare and inject this medication.
When taken to treat hives, the most common side effects are feeling sick to your stomach, getting a cold, sinus and respiratory infections, joint pain or soreness, headache, and cough.
Brand name: Xolair
Remibrutinib
This medication calms part of your immune system, reducing histamine (a chemical inside some cells in your body that can cause hives). Less histamine can decrease hives, itching, and swelling.
The FDA has approved remibrutinib for adults who have a type of hives called chronic spontaneous urticaria and have taken antihistamines without getting relief from the hives or itching. Remibrutinib should not be prescribed to treat any other type of hives.
In clinical trials, patients took this medication twice a day. After taking it twice a day for 12 weeks, 70% of patients had fewer hives and 67% said they had less itching. Of the patients who took this medication for one year, nearly half were able to get complete relief from hives.
If your dermatologist prescribes this medication, you will take a tablet twice a day, every day. Some patients also continue to take an antihistamine.
In clinical trials, the most common side effects were a runny nose, bleeding, headache, nausea, and abdominal pain.
Your dermatologist will watch you for signs of bleeding. As this medication can cause bleeding, be sure to tell your dermatologist the following: All medical conditions that you have, every medication that you take, and if you recently had (or plan to have) surgery.
Brand name: Rhapsido
How do dermatologists treat a child with hives?
Hives often go away on their own.
If hives don’t clear, leaving your child with flare-ups that last for 6 weeks or longer and occur on most days of the week, treatment often begins by trying to find the cause.
Many times, the cause cannot be found. If this happens, your dermatologist may prescribe an antihistamine for your child. Other medications are also FDA approved to treat a child who has hives.
The FDA has approved medications to treat children who have a type of hives called chronic spontaneous urticaria.
How is severe swelling from hives treated?
To treat severe swelling that can occur with hives, your dermatologist may prescribe:
Oral (take by mouth) corticosteroid
An auto-injector pen (epinephrine)
An oral corticosteroid may be prescribed short term if you have swelling in your throat, on your face, or hives on most of your body. It’s essential to take this medication as directed. Once you have some relief, your dermatologist will switch you to another medication.
Some patients may need to carry an auto-injector pen so that they can inject themselves if severe swelling occurs. An auto-injector pen is filled with a single dose of medication called epinephrine (also known as adrenaline).
Brand names (for auto-injector pen): Adrenaclick, Auvi-Q, EpiPen
What are possible side effects of using an epinephrine autoinjector pen?
Using an epinephrine pen can be lifesaving, but possible side effects can occur, which include:
Feeling a bit shaky
Heartbeat speeds up
Problems seeing
Confusion
Dizziness
Get immediate medical care if you develop any of the following side effects after using an auto-injector pen:
Lips, tongue, or throat swells
Shortness of breath
Keep in mind that not all patients develop side effects.
What other medications are used to treat hives?
Your dermatologist may prescribe another medication if antihistamines or other medications described above:
Fail to work
Are not right for you
Other medications that your dermatologist may prescribe include the following:
Doxepin
Considered an alternative treatment, doxepin is an antidepressant medication that can stop histamine from triggering an allergic reaction. It can be helpful for treating adults who have long-lasting hives. Doxepin is also a sedative, so it can help you sleep if hives keep you awake.
Possible side effects include drowsiness, dry mouth, dry eyes, and blurred vision.
Brand names: Silenor, Sinequan
Cyclosporine
This medication can calm the immune system. A calm immune system can prevent new hives. Existing hives clear on their own.
Due to possible side effects, dermatologists carefully select each patient. Before a dermatologist prescribes cyclosporine, each patient needs medical tests. If this medication is prescribed, your dermatologist will monitor you carefully while you take cyclosporine.
Possible side effects include developing high blood pressure or worsening of high blood pressure, even when it’s controlled with medication.
At-home care can help improve results from treatment for hives
A treatment plan often works best when you follow dermatologists’ at-home tips. To see what dermatologists recommend, go to Hives: How to get relief at home.
Images
Image 1: Getty Images
Image 2: Produced with permission from ©DermNet www.dermnetnz.org 2024.
References
Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up.” J Am Acad Dermatol. 2018;79(4):599-614.
Antia C, Baquerizo K, et al. “Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes.” J Am Acad Dermatol. 2018;79(4):617-33.
Grattan CEH, Saini SS. “Urticaria and angioedema.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018:304-19.
Giustozzi MI, Torre AC, et al. “Phototherapy as an alternative in the treatment of chronic spontaneous urticaria.” Front Allergy. 2024 Nov 21;5:1468983.
Hide M, Takahagi S, et al. “Urticaria and angioedema.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:684-785.
LaCava AF, Fadugba OO. “Cyclosporine for omalizumab-refractory chronic urticaria: A report of five cases.” Allergy Asthma Clin Immunol. 2023 Aug 29;19(1):78.
Maurer M, Casale TB, et al. “Dupilumab in patients with chronic spontaneous urticaria (LIBERTY-CSU CUPID): Two randomized, double-blind, placebo-controlled, phase 3 trials.” J Allergy Clin Immunol. 2024 Jul;154(1):184-94.
Metz M, Giménez-Arnau A, et al. “Remibrutinib in chronic spontaneous urticaria.” N Engl J Med. 2025 Mar 6;392(10):984-94.
Package inserts:
Desloratadine and loratadine. Last accessed April 30, 2024.
Dupilumab. Last accessed May 28, 2026.
Remibrutinib. Last accessed October 29, 2025.
Ray SE, Boudewyns V, et al. “Generic substitution of epinephrine autoinjectors: Patient and caregiver perceptions and attitudes.” J Allergy Clin Immunol Glob. 2023 Sep 14;3(1):100170.
Saini SS, Kaplan AP. “Chronic spontaneous urticaria: The devil's itch.” J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1097-1106.
Sheikh G, Latif I, et al. “Role of adjuvant narrow band ultraviolet B phototherapy in the treatment of chronic urticaria.” Indian J Dermatol. 2019 May-Jun;64(3):250.
Stewart J. “Dupixent FDA approval history.” Drugs.com. Last updated 4/23/2025. Last accessed 4/25/2025.
Wong HK. “Urticaria.” In: Medscape (Elston DM., Ed.) Last updated 9/16/2020. Last accessed 4/15/2024.
Written by:
Paula Ludmann, MS
Reviewed by:
Laurel Geraghty, MD, FAAD
Elizabeth Houshmand, MD, FAAD
Morgan Murphrey, MD, FAAD
Last updated: 7/13/26