If you have urticaria, an allergist may advise testing to rule out allergy. This is important because allergic urticaria requires different treatment from non-allergic chronic urticaria. Any medication that you have taken during or prior to urticaria episodes should be investigated as a cause of your urticaria. This may be evaluated by detailed questioning and /or may require you to keep a medication diary. PLEASE BE SURE TO TELL YOUR ALLERGIST ABOUT ALL MEDICATIONS YOU ARE TAKING INCLUDING OVER-THE-COUNTER MEDICATIONS, HERBAL SUPPLEMENTS, VITAMINS AND INJECTIONS, AND BIRTH CONTROL MEDICATIONS.
If no clear allergic cause is found by history, then testing will be ordered. This will usually include a urinalysis (urine sample), blood laboratory tests and possibly x-rays. Occasionally stool samples will be required if parasites are suspected. You will be questioned about your general health, including the approximate dates of your last PAP smear, mammogram, stool blood test and general physical. Most people with chronic urticaria are NOT found to have any underlying disease.
If you are found to have chronic urticaria, treatment to control your symptoms will be prescribed. This will probably include non-drowsy or mildly sedating antihistamines. It is recommended that these be taken on a regular basis to prevent urticaria, rather than “as needed.” Non sedating antihistamines include: loratadine, Claritin, Clarinex, fexofenadine and Allegra. Other antihistamines may cause drowsiness but can be very effective and include: Zyrtec, hydroxyzine (Atarax) and Doxepin.
Additional medications may include H2 blockers (Zantac, Tagamet, or Pepcid) that work with the antihistamines to suppress urticaria. Some anti-asthma medications, such as Accolate or Singulair, may also be prescribed for urticaria since they can suppress chemicals produced by cells that cause hives. If your case of hives is particularly severe, oral corticosteroids such as prednisone or Medrol (methylprednisolone) may be prescribed. Remember corticosteroids are not meant for long-term use, except in rare cases because of their great potential for side effects. Follow your physician’s directions exactly if given oral corticosteroids, and never stop them suddenly if you have been on them for over one week. Allergy shots have not been shown to be effective in treating chronic urticaria.
In occasional cases, urticaria may be resistant to treatment or testing may suggest an underlying problem. In this case a skin biopsy may be needed. Consultation with a dermatologist or other specialists may be indicated in some individuals. Most people with chronic urticaria, however, are able to find a treatment regimen that controls or eliminates their hives.