What to Do When Antihistamines Stop Treating Your Chronic Hives

After a chronic idiopathic urticaria (CIU) diagnosis, your doctor will likely prescribe an oral antihistamine to treat your symptoms. Unfortunately, antihistamines aren't always effective.

If you've already tried an antihistamine and you aren't seeing results, schedule an appointment with your doctor to learn about possible next steps.

Here are some questions you can ask your doctor at your follow-up appointment and some information about what you might hear in response.

It's hard to say why antihistamines work for some people and not for others. But it's not uncommon for antihistamines to be ineffective. Studies on the effectiveness of antihistamines for chronic hives have shown a response rate as low as 44 percent.

After seeing little to no results from an antihistamine, your doctor may suggest that you try any of the following treatments, usually in the following order:

• Increasing the dose of your current antihistamine.
• A different antihistamine or a combination of several different antihistamines. Your doctor may consider switching you to a different antihistamine or putting you on a regimen of two types of antihistamines. For example, they may recommend an H1-antihistamine combined with an H2-antihistamine, which target different receptors in the body.
• Oral corticosteroids. While doctors usually don't recommend prolonged use of steroids due to potential side effects, they may recommend a short course. This is especially likely if your hives are severe or if they're accompanied by swelling.
• Omalizumab (Xolair). Your doctor may recommend omalizumab, a medication that is injected once a month, if your hives are difficult to treat.

By definition, 'chronic' means that your hives will last for six weeks or more. But there's no way to say for sure exactly how long a specific outbreak episode will last. Unfortunately, it could be months or even years.

Each individual welt will probably last for only a day or two, but they're often quickly replaced by new spots.

The good news is that CIU can go away. The condition itself typically lasts anywhere between one and five years.

If you've already been diagnosed with CIU, your doctor believes the cause is unknown and an allergy isn't to blame. But if you suspect that your doctor overlooked an underlying allergy, you may want to consider seeing an allergist.

Even if you can't identify the cause of your CIU, you may be able to pinpoint triggers that bring on outbreaks or increase the severity of your hives.

Pay attention to see if any of the following common triggers seem to affect you:

• pets or pet dander
• exposure to extreme heat or cold
• exposure to direct sunlight
• vigorous exercise
• pressure on the skin
• certain laundry detergents
• stress or anxiety

By understanding your personal triggers, you can put yourself in a better position to avoid them.

Researchers are still studying how changing your diet can impact the severity and duration of CIU flare-ups. A recent preliminary study suggests that an antihistamine diet, where you avoid foods that contain high levels of histamine, can help reduce the severity on an individual level.

Since this and other similar studies only involved a small group of participants, researchers aren't ready to draw wide conclusions about the diet's success rate.

Even so, it may be worth talking to your doctor to see if they suggest that you try changing your diet.

If your medication isn't giving you the relief you need, you can try the following methods to ease itching:

• moisturize regularly with lotion
• use cool water when you shower
• apply a cold compress or an ice pack to affected areas
• try using over-the-counter creams such as calamine lotion
• wear clothing made from 100 percent cotton or 100 percent silk

While none of the above methods will treat your CIU, they can at least provide comfort during a flare-up.

No. Hives are never contagious, so you don't need to worry about spreading them to friends, family members, or others who are in close contact. You also don't have to worry about the hives spreading if you touch other parts of your body after touching your hives.

If you're concerned about what other people will think when they see the welts on your skin, you can ask your doctor to provide a note explaining the nature of CIU and its symptoms. This can be especially useful for school-aged children.

No. While it may be frustrating to learn that antihistamines aren't effective at treating your hives, you don't need to worry that they will leave any permanent marks or scars. Most individual hives last for no longer than 24 hours and should fade and disappear after that.

While most cases of CIU aren't dangerous, there are several warning signs that you should be aware of. Sudden and severe hives can mean you're experiencing an allergic reaction and need urgent medical attention.

If you experience any of the following symptoms alongside a hives outbreak, call 911 or go to the emergency room:

• trouble breathing
• dizziness
• swelling of the lips or tongue
• rapid or irregular heartbeat
• nausea or vomiting

If antihistamines don't work for you, there's no reason to feel like there's something wrong with you. Ask your doctor about possible next steps. Whether that involves a different form of medication or introducing some natural steps to reduce itching, you have options to decrease CIU-related discomfort.