For chronic hives, a health care professional typically prescribes oral antihistamines, oral or injected corticosteroids or injected epinephrine, according to the Asthma and Allergy Foundation of America. Omalizumab is the first biologic medicine approved for use in patients with chronic hives for which other treatments are not effective.
Non-sedating H1 antihistamines, such as loratadine (Claritin), fexofenadine (Allegra) and cetirizine (Zyrtec), are the first antihistamines doctors prescribe to treat chronic hives, advises the Asthma and Allergy Foundation of America. If these do not provide the desired results, the doctor may advise the patient to add H2 antihistamines, such as cimetidine (Tagamet) and ranitidine (Zantac), to the regimen. Though H2 antihistamines are not effective in treating hives on their own, they sometimes produce relief in combination with H1 antihistamines. The next option to try is sedating antihistamines, such as diphenhydramine (Benadryl)and doxepin, which cause drowsiness.
If antihistamines fail to produce results, the doctor may prescribe oral or injected corticosteroids, such as prednisone, to quell the itching, redness and swelling, notes Mayo Clinic. Due to the serious side effects, this option is only used for a short time.
For severe cases of hives, especially when throat swelling is present, a doctor prescribes an epinephrine injection, states the Asthma and Allergy Foundation of America. Omalizumab is effective in treating stubborn cases of hives, but it is expensive, advises Mayo Clinic. The topical tricyclic antidepressant doxepin can help alleviate itching as well.