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When you have itchy, swollen skin for a long time, your main concern is usually finding relief. Chronic hives can be especially frustrating because they last a long time and often start without a clear cause. Unlike acute hives, which may go away quickly, chronic hives stick around for at least six weeks and may persist for months or even a year.
The good news is that you can manage your symptoms with a range of strategies, from over-the-counter (OTC) and prescription medications to lifestyle changes. Learning about the various treatment options for chronic hives can help you take charge of your symptoms and your health.
Your skin contains special immune cells called mast cells. When these cells are triggered, they release histamine. This chemical causes your blood vessels to swell and leak fluid, which can make your skin look discolored and feel itchy and swollen. Antihistamines work by blocking the effects of histamine.
Second-generation antihistamines are usually the first treatment recommended for people diagnosed with chronic hives. Many of these medications are available OTC and are easy to find for itch relief. Common examples include:
These drugs block H1 receptors found on the surface of cells, which helps stop histamine from causing itching and swelling. Unlike first-generation antihistamines, second-generation ones are nondrowsy and usually won’t make you feel sleepy.
If your antihistamine isn’t working well enough, your healthcare provider may recommend a higher dose of a second-generation antihistamine.
First-generation antihistamines work in a similar way but tend to cause more side effects, especially drowsiness, so second-generation antihistamines are usually preferred.
The sedating effects can sometimes be helpful if you have trouble sleeping at night due to chronic hives, but first-generation antihistamines can be unsafe for some people. These medications may not be appropriate for children under age 6 or older adults.
If your hives still bother you after trying a higher dose of antihistamines, your healthcare provider might recommend an additional treatment, such as a leukotriene receptor antagonist. These medications work by blocking inflammatory chemicals called leukotrienes, which are released by mast cells and other immune cells.
Antihistamines are the first-line treatment for chronic hives, but they don’t work for everyone. If you still have symptoms after taking antihistamines, your doctor may recommend other options.
Doxepin is an antidepressant that can also block the effects of histamine. Possible side effects include dry mouth, dry eyes, and blurred vision. Because it can make you feel drowsy, doxepin could be most useful for people who have symptoms that keep them awake at night.
Cyclosporine is an immunosuppressant, another alternative your doctor may suggest if antihistamines aren’t controlling your symptoms. Immunosuppressants work by dampening the immune system to prevent hives from developing.
Doctors usually try other treatments before cyclosporine because it can raise blood pressure. If you’re taking cyclosporine, your doctor will closely monitor your blood pressure.
Corticosteroids help reduce inflammation and swelling. These anti-inflammatory medications work by acting like cortisol, the body’s natural stress hormone, which helps calm the immune system. Corticosteroids may be prescribed as an oral medication (taken by mouth) or, for itch relief only, as a cream you put on your skin.
Oral corticosteroids can provide powerful short-term relief for severe symptoms, but they can have serious side effects, especially if used long term. Healthcare providers typically recommend oral steroids only for short-term relief from chronic hives.
If high-dose antihistamines don’t work, healthcare providers may try advanced therapies called biologics (medications made from living organisms). Biologics may be used when hives are resistant to other forms of treatment, which indicates a more severe case of the disease.
Omalizumab (Xolair) is a common biologic used for severe chronic hives that don’t get better with antihistamines. Omalizumab targets immunoglobulin E (IgE), an antibody (immune system protein) involved in allergic reactions. By targeting IgE, omalizumab helps stop mast cells from releasing histamine.
Omalizumab is given as an injection into the skin once every two or four weeks. This drug has been shown to provide long-term relief for people whose hives don’t respond to other treatments.
Dupilumab (Dupixent) is another biologic your doctor might prescribe. This drug can help reduce severe symptoms because it has strong anti-inflammatory and anti-itch effects. Like omalizumab, dupilumab is injected under the skin.
Remibrutinib (Rhapsido) is another option for people with chronic hives whose symptoms aren’t relieved by antihistamines. In September 2025, the FDA approved remibrutinib for treating chronic spontaneous urticaria.
Rhapsido targets a protein called Bruton’s tyrosine kinase (BTK), which helps immune cells release histamine and other chemicals that cause hives. As a BTK inhibitor, remibrutinib blocks this protein to help prevent the release of histamine. If you develop side effects such as bleeding, nasal congestion, or sore throat while taking this medication, talk to your healthcare provider.
If your hives are very itchy and you want extra relief, you can try using anti-itch creams. Some of these products are available OTC, whereas others require a prescription from your doctor.
Menthol creams can provide a cool and soothing effect. You could also try pramoxine or calamine lotion. Although these creams won’t treat the underlying cause of chronic hives, they can provide some relief from itching.
Medication is an important part of managing chronic hive symptoms, but several lifestyle changes can also provide daily relief and help minimize flares. These adjustments are important steps in your treatment plan.
It can be difficult to avoid triggers when you have chronic spontaneous urticaria — chronic hives with no clear cause. But for people who have chronic inducible urticaria, a type with a known trigger, this step is very important.
If you’re trying to figure out what brings on your hives, you can keep a diary to track factors such as what you ate or what you were doing when you noticed symptoms. Sometimes you can find a specific trigger, but hives often happen without one. Even if the cause is unclear, treatment can still provide relief.
Stress can trigger hives. To manage stress and help control your symptoms, you might try practicing mindfulness, performing light exercise, or spending time with loved ones. Calming activities like these can help reduce flare-ups so you feel better.
On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.
What treatments have you used to improve your quality of life when living with chronic hives? Let others know in the comments below.
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