Eliminating or avoiding an identified source or cause
if a trigger is identified is the best way to treat hives.
If hives occur, and particularly in the case of Recurrent Spontaneous Urticaria, medications can be used to treat hives.
First line treatment: Non-sedating oral antihistamines are prescribed, as often as four times a day.
If the hives continue, sedating antihistamines may be prescribed. In addition other types of medications may be prescribed (H2 antagonists, tricyclic antidepressants or leukotriene modifiers).
For acute severe flares of hives, a course of oral steroids may be prescribed. Oral steroids should be used cautiously and tapered off as quickly as possible because of the potential for serious side effects.
For chronic, severe urticaria, omalizumab has been shown be be effective. This is a medication given as a shot every 4 weeks. Oral immunosuppressive agents can also be tried if the urticaria are is not responding to omalizumab.
Avoidance of Things that Make Hives Worse
People known to get hives should try to avoid things that make them worse, such as infections, NSAIDs, alcohol, stress, heat or exertion.