Can I take 2 antihistamines for hives

Cetirizine - Brand names: Allacan, Benadryl Allergy, Piriteze Allergy, Zirtek Allergy

If you or your child have been prescribed cetirizine, follow your doctor's instructions about how and when to take it. If it is from a pharmacy or shop, follow the instructions that come with the packet.

Dosage and strength

Cetirizine comes as tablets and capsules (10mg) and as a liquid medicine (labelled either 5mg/5ml or 1mg/1ml).

The usual dose for adults is 10mg once a day.

Doses are usually lower for people with kidney problems.

Children

• For children between 6 to 11 years of age, the usual dose is 5mg, twice a day. Try to leave 10 to 12 hours between doses. So, one first thing in the morning, and one before bedtime.
• For children between 2 to 5 years of age, the dose is 2.5mg, twice a day.
• For children between 1 to 2 years of age, your doctor will use their weight or age to work out the right dose.

How to take it

You can take cetirizine with or without food, but always take the tablets or capsules with a drink of water, milk or squash. Swallow them whole. Do not chew them.

Cetirizine liquid may be easier for children to take than tablets. The liquid medicine will come with a plastic syringe or spoon to give the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure out the right amount.

When to take it

You may only need to take cetirizine on a day you have symptoms for example, if you have been in contact with something that has triggered your allergy, like animal hair.

Or you may need to take it regularly to prevent symptoms for example, to stop hay fever during spring and summer.

What if I forget to take it?

Take your forgotten dose as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a forgotten dose.

If you forget to give a dose to a child who is taking cetirizine twice a day, you can give the missed dose if it's within 4 hours of when they should have had it.

If you remember more than 4 hours after, do not give the missed dose. Instead, wait until the next dose and carry on as normal.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Cetirizine is generally very safe. Taking more than the usual dose is unlikely to harm you or your child.

If you take an extra dose, you might get some of the common side effects. If this happens or you're concerned, contact your doctor.

What to Do When Antihistamines Arent Working for Hives

Antihistamines may not work for some people, depending on the severity of their hives. You may need an increased dosage or a different medication altogether.

After a chronic idiopathic urticaria (CIU) diagnosis, your doctor will likely prescribe an oral antihistamine to treat your symptoms. However, antihistamines arent always effective.

If youve already tried an antihistamine and you arent 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.

Its hard to say why antihistamines work for some people and not for others. But its not uncommon for antihistamines to be or become ineffective.

Research on the effectiveness of antihistamines for chronic hives has shown a response rate as low as 43%. It took a secondary treatment with additional medications to bring 28% of the subjects into remission.

Antihistamines may stop working because hives can become worse over time or because the intensity of hives can wax and wane over time.

Its also possible that antihistamines become less effective because people arent taking them as prescribed.

Even if you cant identify the cause of your CIU, you may be able to pinpoint triggers that bring on outbreaks or increase the severity of your hives.

See whether 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
• stress or anxiety
• nonsteroidal anti-inflammatory drugs (like ibuprofen)

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

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

• Higher dose: Sometimes increasing the dose of your current antihistamine can yield better results.
• 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 targets different receptors in the body.
• Oral corticosteroids. While doctors usually dont 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 theyre accompanied by swelling.
• Cyclosporine (Gengraf, Neoral, Sandimmune): This is an immunosuppressant drug that has led to remission from hives in 50% of cases, according to research.
• Omalizumab (Xolair). Your doctor may recommend omalizumab, a medication thats injected once a month if your hives are difficult to treat, but is effective in 80% of cases.
• Leukotriene receptor antagonists (LTRAs): Two drugs, zafirlukast (Accolate) and montelukast, might be prescribed in cases of hives caused by Aspirin, and there isnt enough data on their effectiveness on hives overall.

If your medication isnt 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 loose clothing made from 100% cotton or 100% silk.

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

Dietary changes to help prevent hives

Researchers are still studying whether changing your diet can impact the severity and duration of CIU flare-ups.

A 2018 preliminary Korean study suggests that an antihistamine diet, where you avoid foods that contain high levels of histamine, may help reduce the severity on an individual level.

Since this and other similar studies only involved a small group of participants, researchers arent ready to draw wide conclusions about the diets success rate.

Even so, it may be worth talking with your doctor to see whether changing your diet is a good option.

No. Hives are never contagious, so you dont need to worry about spreading them to friends, family members, or others who are in close contact.

You also dont have to worry about the hives spreading if you touch other parts of your body after touching your hives.

If youre 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 arent effective at treating your hives, you dont need to worry that they will leave any permanent marks or scars.

Most hives last for no longer than 24 hours and should fade and disappear after that.

While most cases of CIU arent dangerous, there are several warning signs that you should be aware of. Sudden and severe hives can mean youre experiencing an allergic reaction and need urgent medical attention.

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

By definition, chronic means that your hives will last for 6 weeks or more. But theres no way to say for sure exactly how long a specific outbreak episode will last. It could be months or even years.

Each individual welt will probably last for several hours, but theyre often quickly replaced by new ones.

The good news is that CIU can go away, its just hard to predict when.

Should I see an allergist?

If youve already been diagnosed with CIU, your doctor believes the cause is unknown and an allergy isnt to blame. But if you suspect that your doctor overlooked an underlying allergy, you may want to consider seeing an allergist.

What happens if hives dont go away with Benadryl?

Benadryl (diphenhydramine) is an over-the-counter antihistamine that can be used to treat mild allergic reactions, including hives. It is an H1 antihistamine, which means it is one of the ones your doctor may want you to try first. It is also available in higher doses as a prescription if the OTC version doesnt work for you. If its still ineffective, your doctor will likely switch you to H2 antihistamines, other medications, or a combination of drugs.

Why is Benadryl not stopping my allergic reaction?

If there is an ongoing trigger for your hives in your environment, you might continue to develop them or they may worsen even if youre taking an antihistamine like Benadryl. In addition to taking medication, its important to try to identify the trigger and eliminate it. To do this, make an appointment with a dermatologist or allergist for testing, and track your flare-ups. That said, sometimes there is no identifiable cause. Make sure you are taking your medication exactly as prescribed or following the directions on the box of any OTC drug.

If antihistamines dont work for you, dont become discouraged. This happens for certain people and under certain circumstances.

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.

Allergy medications: Know your options

Allergy medications: Know your options

Several types of medications are used to treat allergy symptoms. Here's more information.

By Mayo Clinic Staff

Allergy medications are available as pills, liquids, inhalers, nasal sprays, eyedrops, skin creams and shots (injections). Some are available over-the-counter; others are available by prescription only. Here's a summary of the types of allergy medications and why they're used.

Antihistamines

Antihistamines block histamine, a symptom-causing chemical released by your immune system during an allergic reaction.

Pills and liquids

Oral antihistamines are available over-the-counter and by prescription. They ease a runny nose, itchy or watery eyes, hives, swelling, and other signs or symptoms of allergies. Because some of these drugs can make you feel drowsy and tired, take them with caution when you need to drive or do other activities that require alertness.

Antihistamines that tend to cause drowsiness include:

• Diphenhydramine
• Chlorpheniramine

These antihistamines are much less likely to cause drowsiness:

• Cetirizine (Zyrtec, Zyrtec Allergy)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra, Allegra Allergy)
• Levocetirizine (Xyzal, Xyzal Allergy)
• Loratadine (Alavert, Claritin)

Nasal sprays

Antihistamine nasal sprays help relieve sneezing, itchy or runny nose, sinus congestion, and postnasal drip. Side effects of antihistamine nasal sprays might include a bitter taste, drowsiness or feeling tired. Prescription antihistamine nasal sprays include:

• Azelastine (Astelin, Astepro)
• Olopatadine (Patanase)

Eyedrops

Antihistamine eyedrops, available over-the-counter or by prescription, can ease itchy, red, swollen eyes. These drops might have a combination of antihistamines and other medicines.

Side effects might include headache and dry eyes. If antihistamine drops sting or burn, try keeping them in the refrigerator or using refrigerated artificial-tear drops before you use them. Examples include:

• Ketotifen (Alaway, Zaditor)
• Olopatadine (Pataday, Patanol, Pazeo)
• Pheniramine and naphazoline (Visine, Opcon-A, others)

Decongestants

Decongestants are used for quick, temporary relief of nasal and sinus congestion. They can cause trouble sleeping, headache, increased blood pressure and irritability. They're not recommended for people with high blood pressure, cardiovascular disease, glaucoma or hyperthyroidism.

Pills and liquids

Oral decongestants relieve nasal and sinus congestion caused by hay fever (allergic rhinitis). Many decongestants, such as pseudoephedrine (Sudafed), are available over-the-counter.

A number of oral allergy medications contain a decongestant and an antihistamine. Examples include:

• Cetirizine and pseudoephedrine (Zyrtec-D 12 Hour)
• Desloratadine and pseudoephedrine (Clarinex-D)
• Fexofenadine and pseudoephedrine (Allegra-D)
• Loratadine and pseudoephedrine (Claritin-D)

Nasal sprays and drops

Nasal decongestant sprays and drops relieve nasal and sinus congestion if used only for a short time. Repeated use of these drugs for more than three consecutive days may result in a cycle where congestion recurs or gets worse. Examples include:

• Oxymetazoline (Afrin)
• Tetrahydrozoline (Tyzine)

Corticosteroids

Corticosteroids relieve symptoms by suppressing allergy-related inflammation.

Nasal sprays

Corticosteroid sprays prevent and relieve stuffiness, sneezing and runny nose. Side effects can include an unpleasant taste, nasal irritation and nosebleeds. Examples include:

• Budesonide (Rhinocort)
• Fluticasone furoate (Flonase Sensimist)
• Fluticasone propionate (Flonase Allergy Relief)
• Mometasone (Nasonex)
• Triamcinolone (Nasacort Allergy 24 Hour)

For people who are bothered by the feeling of liquid running down their throats or the unpleasant taste of these sprays, there are two aerosol formulas:

• Beclomethasone (Qnasl)
• Ciclesonide (Zetonna)

Inhalers

Inhaled corticosteroids are often used daily as part of treatment for asthma caused or complicated by reactions to airborne allergy triggers (allergens). Side effects are generally minor and can include mouth and throat irritation and oral yeast infections.

Some inhalers combine corticosteroids with long-acting bronchodilators. Prescription inhalers include:

• Beclomethasone (Qvar Redihaler)
• Budesonide (Pulmicort Flexhaler)
• Ciclesonide (Alvesco)
• Fluticasone (Flovent)
• Mometasone (Asmanex Twisthaler)

Eyedrops

Corticosteroid eyedrops are used to relieve persistent itchy, red or watery eyes when other interventions aren't effective. A physician specializing in eye disorders (ophthalmologist) usually monitors the use of these drops because of the risk of problems, such as cataracts, glaucoma and infection. Examples include:

• Fluorometholone (Flarex, FML)
• Loteprednol (Alrex, Lotemax)
• Prednisolone (Omnipred, Pred Forte, others)

Pills and liquids

Oral corticosteroids are used to treat severe symptoms caused by all types of allergic reactions. Long-term use can cause cataracts, osteoporosis, muscle weakness, stomach ulcers, increased blood sugar (glucose) and delayed growth in children. Oral corticosteroids can also worsen high blood pressure.

Prescription oral corticosteroids include:

• Prednisolone (Prelone)
• Prednisone (Prednisone Intensol, Rayos)
• Methylprednisolone (Medrol)

Skin creams

Corticosteroid creams relieve allergic skin reactions such as itching, redness or scaling. Some low-potency corticosteroid creams are available without a prescription, but talk to your doctor before using these drugs for more than a few weeks.

Side effects can include skin discoloration and irritation. Long-term use, especially of stronger prescription corticosteroids, can cause thinning of the skin and abnormal hormone levels. Examples include:

• Betamethasone (Dermabet, Diprolene, others)
• Desonide (Desonate, DesOwen)
• Hydrocortisone (Locoid, Micort-HC, others)
• Mometasone (Elocon)
• Triamcinolone

Mast cell stabilizers

Mast cell stabilizers block the release of chemicals in the immune system that contribute to allergic reactions. These drugs are generally safe but usually need to be used for several days to produce the full effect. They're usually used when antihistamines are not working or not well-tolerated.

Nasal spray

Over-the-counter nasal sprays include cromolyn (Nasalcrom).

Eyedrops

Prescription eyedrops include the following:

• Cromolyn (Crolom)
• Lodoxamide (Alomide)
• Nedocromil (Alocril)

Leukotriene inhibitors

A leukotriene inhibitor is a prescription medication that blocks symptom-causing chemicals called leukotrienes. This oral medication relieves allergy signs and symptoms including nasal congestion, runny nose and sneezing. Only one type of this drug, montelukast (Singulair), is approved for treating hay fever.

In some people, leukotriene inhibitors can cause psychological symptoms such as anxiety, depression, strange dreams, trouble sleeping, and suicidal thinking or behavior.

Allergen immunotherapy

Immunotherapy is carefully timed and gradually increased exposure to allergens, particularly those that are difficult to avoid, such as pollens, dust mites and molds. The goal is to train the body's immune system not to react to these allergens.

Immunotherapy might be used when other treatments aren't effective or tolerated. It is also helpful in reducing asthma symptoms in some patients.

Shots

Immunotherapy may be given as a series of injections, usually one or two times a week. The dose may be increased weekly or every two weeks based on the patient's tolerance. Injections of the maximum tolerated dose may then be given every two to four weeks year round.

Side effects might include irritation at the injection site and allergy symptoms such as sneezing, congestion or hives. Rarely, allergy shots can cause anaphylaxis, a sudden life-threatening reaction that causes swelling in the throat, difficulty breathing, and other signs and symptoms.

Sublingual immunotherapy (SLIT)

With this type of immunotherapy, you place an allergen-based tablet under your tongue (sublingual) and allow it to be absorbed. This treatment has been shown to reduce runny nose, congestion, eye irritation and other symptoms associated with hay fever. It also improves asthma symptoms.

One SLIT tablet contains dust mites (Odactra). Several SLIT tablets contain extracts from pollens of different types of grass, including the following:

• Short ragweed (Ragwitek)
• Sweet vernal, orchard, perennial rye, Timothy and Kentucky blue grass (Oralair)
• Timothy grass (Grastek)

Biological medications

Some medications target a specific reaction in the immune system and try to prevent it from happening. These medications are given as injections. They include dupilumab (Dupixent) to treat allergic skin reactions and omalizumab (Xolair) to treat asthma or hives when other medications don't help.

Side effects of biological medications may include redness, itchiness, or irritation of the eyes and irritation at the injection site.

Emergency epinephrine shots

Epinephrine shots are used to treat anaphylaxis, a sudden, life-threatening reaction. The drug is administered with a self-injecting syringe and needle device (auto-injector). You might need to carry two auto-injectors if there's a chance you could have a severe allergic reaction to a certain food, such as peanuts, or if you're allergic to bee or wasp venom.

A second injection is sometimes needed. As a result, it's important to call 911 or get immediate emergency medical care.

A health care professional will train you on how to use an epinephrine auto-injector. It's important to get the type that your doctor prescribes, as the method for injection may differ slightly for each brand. Also, be sure to replace your emergency epinephrine before the expiration date.

Examples of these medications include:

• Adrenaclick
• Auvi-Q
• EpiPen
• EpiPen Jr

Get your doctor's advice

Work with your doctor to choose the most effective allergy medications and avoid problems. Even over-the-counter allergy medications have side effects, and some allergy medications can cause problems when combined with other medications.

It's especially important to talk to your doctor about taking allergy medications in the following circumstances:

• You're pregnant or breast-feeding.
• You have a chronic health condition, such as diabetes, glaucoma, osteoporosis or high blood pressure.
• You're taking other medications, including herbal supplements.
• You're treating allergies in a child. Children need different doses of medication or different medications from adults.
• You're treating allergies in an older adult. Some allergy medications can cause confusion, urinary tract symptoms or other side effects in older adults.
• You're already taking an allergy medication that isn't working. Bring the medication with you in its original bottle or package when you see your doctor.

Keep track of your symptoms, when you use your medications and how much you use. This will help your doctor figure out what works best. You might need to try a few medications to determine which are most effective and have the least bothersome side effects for you.

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March 05, 2022Show references

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