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The first and most important step is if there’s a known cause, eliminate that exposure. For example, avoiding nuts and even products that were produced in a facility processing nuts will be beneficial. For adult life-threatening hives epinephrin is the treatment of choice. Either self administered, hence the epipen, or at an emergency medical facility. Difficulty breathing, shortness of breath, wheezing, swelling tongue, lips, or throat, tightness in the chest and dizziness are all imperative to be treated in an emergency situation. If there is no avoidable cause, known or unknown, anti-histamines are the usual secondary therapy. They range from medications without any side effects to drugs that cause extreme drowsiness. Your response and the severity of your illness will determine the appropriate regimen. For more severe cases, systemic corticosteroids, oral or intramuscular, may be prescribed. Omalizumab, Xolair, is also approved to treat hives. Xolair is a new type of medication. It is a monoclonal antibody that binds to IgE in the bloodstream. This allows the body to eliminate these causative antibodies. Most of the time hives are self-limited, which means that they will disappear within six weeks. For others, knowing the causative agent trigger is sufficient to afford control.
