The primary goal of treatment is to reduce itching and prevent hives from returning. Keeping a journal of potential triggers can help identify any causes, and avoiding known triggers is key.

The main medical treatment for hives involves oral antihistamines, which are often available over-the-counter. These include non-sedating options such as loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra), as well as the more sedating diphenhydramine (Benadryl). Prescription options like hydroxyzine (Atarax) and desloratadine (Clarinex) may also be used.

Topical anti-itch creams, such as over-the-counter lotions with pramoxine, calamine, or menthol, can temporarily ease symptoms. A topical steroid cream, lotion, or ointment may be prescribed, and oral steroids may be used short-term if hives are widespread.

Managing chronic urticaria can be complex and may require varied approaches. If antihistamines and topical treatments are not effective, immunosuppressant therapy may be considered to reduce the immune response, sometimes involving referral to an allergist.

If hives are accompanied by symptoms like lip swelling, difficulty swallowing or breathing, lightheadedness, or a racing heartbeat, it is essential to seek emergency care promptly.