When treating chronic idiopathic urticaria, your health team will likely take a “step-up” approach, Camp says. This means starting with a conservative, over-the-counter option and then bringing in different options if those don’t prevent recurrences or lead to symptom relief.
Antihistamines
The first line of therapy for most cases of chronic idiopathic urticaria are non-sedating over-the-counter antihistamines, also called H1 antihistamines, says Camp.
“These medications block the effect of histamine, a chemical signal released in response to inflammation that leads to redness, swelling, and itching and the formation of hives,” he says.
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Medications that don’t have a sedating effect (also known as second generation H1 antihistamines) tend to be better because they can be taken at any time of the day, rather than just in the evening, he says. These include:
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- loratadine (Claritin)
- desloratadine (Clarinex)
- cetirizine (Zyrtec)
- fexofenadine (Allegra)
Antihistamines known to cause drowsiness (also known as first generation H1 antihistamines) include:
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- diphenhydramine (Benadryl, Banophen)
- chlorpeniramine (Chlor-Trimeton, Ahist, Aller-Chlor)
- doxylamine (Unisom)
- brompheramine (BroveX CT)
- hydroxyzine (Atarax, Rezine, Vistaril)
- clemastine (Dayhist, Tavist Allergy)
- cyproheptadine (Periactin)
- dimenhydrinate (Dramamine)
Prescription H2 Blockers
Also known as H2 antihistamines, these medications work by reducing stomach acid production, which blocks histamine receptors in the stomach. Commonly prescribed for certain gastrointestinal issues, these meds can also affect histamine receptors in blood vessels, which can help alleviate redness and swelling related to hives.
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Options include:
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- famotidine (Pepcid)
- cimetidine (Tagamet)
- nizatidine (Axid)
“Treatment would be escalated to these medications if the over-the-counter options aren’t reducing symptoms such as itch or flares,” says Camp. “This treatment would also be considered if hives are having a significant, negative impact on quality of life, such as interference with work, relationships, or sleep.”
It’s possible to combine both H1 and H2 antihistamines, depending on the severity of your symptoms, he says. Research noted that a combination like this is statistically more effective than H1 antihistamines alone for symptoms of chronic urticaria.
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