I have had chronic hives for the past six months. The only thing that controls them temporarily is prednisone. As soon as I am off of it, they come back with a vengeance within 24 hours or less. Is there anything else that might help? I already take Zyrtec and Zantac. I am desperate and would appreciate any suggestions.
— Gail, Massachusetts
Hives are raised, intensely itchy spots or patches that appear in crops, last for a few hours, and then resolve without leaving any residual marks on the skin. They can range in size from as big as a pencil eraser to the size of a dinner plate. Hives can appear anywhere on the body, although the legs, arms, abdomen, armpits, and neck are the areas where they most commonly surface. Most people will develop hives at least once in their lives, and the trigger is often not obvious.
"Chronic hives" are hives that occur in episodes, daily or nearly every day, for more than six weeks. For a benign condition, hives certainly cause a lot of suffering for those that have them. As your doctor has probably mentioned, there is no identifiable allergy or underlying medical condition to explain chronic hives in about 85 percent of those who suffer from them.
If you visit the message boards on this site, you will find plenty of people writing in under the thread titled, "Crazy Itching." Just reading through what others have posted, you can get a sense of how exasperating this problem can get. Also, you can see that different treatments work for different people, and what seems to be a miracle treatment for one person has minimal effect on another.
The bottom line is this: There are no magic cures for hives. Most of the time, people try various medications until they find some combination that works for them.
The combination of Zantac (ranitidine) and Zyrtec (cetirizine) helps many people, although you may need to double the regular Zyrtec dose to 10 mg twice a day for decent relief. The Zantac you take should be at least 150 mg twice a day.
In addition to this, some people benefit from 10 to 20 mg of doxepin before bed. Doxepin is an antidepressant when taken at higher doses, but at lower doses acts as a strong antihistamine. It is very sedating however, and some people feel groggy in the morning. Another antihistamine that can be helpful is hydroxyzine, taken at a dosage of 25 mg every six to eight hours if needed, although it is also sedating.
Prednisone will calm down hives in most cases, but it can have severe side effects if taken continuously for months or years. Dramatic and sudden changes in medication often cause the hives to flare again, so sometimes I have success lowering the prednisone dose very, very slowly. For example, once you get down to 10 mg, try dropping one milligram every four days or so: in other words, 9 mg a day for four days; 8 mg a day for the next four days, etc. Once you reach 4 or 5 mg, try changing to taking prednisone every other day for a week, and then stop. When lowering and stopping the prednisone, you also have to keep the antihistamines going at full strength, and if you're lucky, they will offer enough relief by themselves.
Make sure you are not inadvertently doing anything that could be aggravating the hives. Things that seem to aggravate hives and itching in most everyone include:
- Dramatic temperature changes (hot showers, cooling down after a workout)
- Medications like aspirin and other over-the-counter pain medications. (Acetaminophen — Tylenol or generic — is usually fine.)
- Poor sleep
- Dramatic changes in diet (rich restaurant meals, very spicy foods)
- Nighttime. Hives and itching often worsen at night because that's when the body's natural anti-itch chemicals are at their lowest.
This list is just good to keep in mind if you have an itching problem, even if you can't control many of the things on it. Try to keep your eating and sleeping patterns as regular as possible.
Learn more in the Everyday Health Allergy Center.
Last Updated: 4/17/2007