Chronic Idiopathic Urticaria Treatment: Medication, Lifestyle Changes, and More

The term "idiopathic" means the cause of the hives isn't identifiable — for example, it's not prompted by an allergic reaction or a known infection. “Chronic” means the hives last longer than six weeks, says Brendan Camp, MD, a dermatologist at MDCS Dermatology in New York City. This is in contrast to acute hives, which occur infrequently for a shorter duration, sometimes for only minutes at a time before they begin to resolve, he says.

Just because the condition is chronic doesn't mean you'll have it for life. Effective treatment can limit and sometimes completely alleviate recurring episodes of hives, Dr. Camp says. Addressing chronic hives usually involves over-the-counter treatment initially, followed by prescription medications if those don't work well.

As with any condition, be sure to talk with your doctor before starting a treatment or combining treatments to create a plan that best fits your needs.

When treating chronic idiopathic urticaria, your health team will likely take a "step-up" approach, Camp says. This means starting with a conservative, over-the-counter option and then bringing in different options if those don't prevent recurrences or lead to symptom relief.

Antihistamines

The first line of therapy for most cases of chronic idiopathic urticaria are non-sedating over-the-counter antihistamines, also called H1 antihistamines, says Camp.

• loratadine (Claritin)
• desloratadine (Clarinex)
• cetirizine (Zyrtec)
• fexofenadine (Allegra)

• diphenhydramine (Benadryl, Banophen)
• chlorpeniramine (Chlor-Trimeton, Ahist, Aller-Chlor)
• doxylamine (Unisom)
• brompheramine (BroveX CT)
• hydroxyzine (Atarax, Rezine, Vistaril)
• clemastine (Dayhist, Tavist Allergy)
• cyproheptadine (Periactin)
• dimenhydrinate (Dramamine)

Prescription H2 Blockers

• famotidine (Pepcid)
• cimetidine (Tagamet)
• nizatidine (Axid)

"Treatment would be escalated to these medications if the over-the-counter options aren't reducing symptoms such as itch or flares," says Camp. "This treatment would also be considered if hives are having a significant, negative impact on quality of life, such as interference with work, relationships, or sleep."

Biologics

If H2 blockers are also proving ineffective, even in combination with H1 antihistamines, the next step in treatment is to consider biologic medications.

BTK Inhibitors

In September 2025, the FDA approved remibrutinib (Rhapsido). Remibrutinib is the first Bruton's tyrosine kinase (BTK) inhibitor approved by the FDA to treat chronic hives in adults whose symptoms are not relieved with H1 antihistamines. Remibrutinib is an oral pill taken twice a day. It works by targeting and blocking the BTK protein, which is thought to help stop inflammatory chemicals like histamine from being released inside the body.

Other possible side effects include:

• Nasal congestion
• Sore throat
• Runny nose
• Headache
• Nausea
• Stomach pain

Other Medication Options

• corticosteroids like prednisone
• leukotriene antagonists
• hydroxychloroquine
• cyclosporine

Medications are the primary form of treatment for chronic hives, but lifestyle habits can be helpful as well, says Camp. These can include:

• Identify triggers. Although this type of hives is idiopathic, certain allergens can bring on episodes or make them worse, Camp says. Triggers may include food allergies and sensitivities, insect bites, pollen, medications, and pet dander, among others.

  [12]

• Avoid temperature extremes. For some people, extreme hot (especially humid) or cold temperatures can trigger symptoms. Because of that, it may be useful to maintain a consistent temperature to reduce chronic urticaria episodes.

  [12]

• Prevent friction. Skin irritation from friction can be another source of flares. Avoid tight clothing that creates friction, says Camp.
• Moisturize often. As another way to reduce irritation, keep skin hydrated through use of a moisturizer, Camp says. Be sure to choose one that's unscented, since fragrances may be problematic when skin is sensitive.

While stress isn't considered a direct cause of chronic urticaria, it can be a contributing factor for symptom flares, says Geeta Yadav, MD, a dermatologist and the founder of FACET Dermatology in Toronto.

"It is extremely important for anyone with immune- and inflammatory-related skin conditions, like hives, eczema, and psoriasis, to prioritize reducing emotional and physical stress as part of urticaria management," she says. "While reducing stress is easier said than done, it can go a long way toward reducing disease activity and severity."

• There’s a range of treatment options available for chronic idiopathic urticaria: hives with no known cause that last at least six weeks.
• Although chronic idiopathic urticaria can be frustrating, and sometimes cause emotional difficulties, the condition is often managed with a step-up treatment plan. This means starting with over-the-counter antihistamines that may alleviate symptoms and prevent new episodes, and if those prove ineffective, your doctor may recommend a prescription antihistamine, biologic medication, or BTK inhibitor.
• Lifestyle changes like identifying triggers, avoiding temperature extremes, and maintaining good skin health can also be a useful complement to medications suggested by your health provider.