Treatment
Urticaria may not require medical treatment, with flare-ups often resolving on their own within a short amount of time.
If you have more severe symptoms or your symptoms are lasting, speak to a pharmacist or your doctor, who may recommend that you take antihistamines, which are generally available to buy over the counter.1
It’s worth being aware that some antihistamines (particularly over the counter) cause drowsiness, so you should avoid driving or operating heavy machinery if you feel tired when taking these. Taking them at night can help to reduce the drowsy feeling.
For many people, no treatment or simple over-the-counter antihistamines are enough to manage their symptoms. Some people find lifestyle changes or at-home remedies can also provide relief from symptoms and will be covered more in Living with Urticaria section. Some find that their symptoms cannot be managed this way and require a stronger prescription medication.1
Medication
Medication options are often explained with the analogy of a ladder or stairs that can be stepped up or down depending on the severity of the symptoms and their impact.
First step
Once a diagnosis has been established, the first step is using second-generation H1 Antihistamines.2 These are antihistamines that specifically target receptors involved in allergic reactions and your immune system response. These are often taken orally as tablets, and it may take some time to establish the correct dose for you.
Second step
After increasing the dose of H1 Antihistamines, the second step is adding another antihistamine or leukotriene receptor antagonist into your regime.2 These are oral tablets designed to help deal with inflammation and control symptoms of flare-ups.
Third Step
At this point, if any of the current medication does not appear to be working, it will likely be discontinued, and you may be offered an increased dose of more potent first-generation antihistamines.2
Fourth Step
If this is still having no effect, stronger medications will be considered at step four. These can include:2
- An immune suppressant and/or,
- Corticosteroids (oral tablets): a class of drug that are used to treat inflammation and/or,
- Biologics: block part of the body’s immune response.
Biologics and biosimilars
Sometimes, medication options such as antihistamines and others described in the section “medication” are not effective in controlling CU. For some people, biologics may be an option.
Biologic medicines refer to medicines made from a biological source, such as living cells and organisms. “Biosimilars” is another term that may be used when talking about biologics. Biosimilars are biological medicines which are highly similar to the original biologic reference medicine in terms of quality, safety and efficacy. This means there is no clinically meaningful difference to the original biologic medicine.
All biologics are given by injection, which is usually done by your doctor or nurse. For CU, it is an injectable prescription used in adults or young people 12 years of age or older.
If you are worried about any of the side effects from your medication or if your symptoms are not improving, you should contact your doctor.
The aim is to use these medications to get a CU flare up under control and then “step-down”.2 Your doctor might suggest withdrawing antihistamines periodically to identify spontaneous remission.
References
- Chronic hives - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. 2018. Available from: https://www.mayoclinic.org/diseases-conditions/chronic-hives/diagnosis-treatment/drc-20352723. Last accessed April 2025.
- Hon KL, Leung AKC, Ng WGG, Loo SK. Chronic Urticaria: An Overview of Treatment and Recent Patents. Recent Patents on Inflammation & Allergy Drug Discovery. 2019 Aug 5;13(1):27–37.