Chronic hives guide

Chronic hives plan, online

For adults 18 or older whose chronic hives were already diagnosed in person. A doctor may send a plan that raises your antihistamine above the label dose, in steps. We do not order tests.

Start online

Start a $59 online review for Chronic hives.

Hives are itchy, raised welts on the skin. Some people have them for 6 weeks or longer with no clear cause. Doctors call this chronic spontaneous hives. The first treatment is a daily antihistamine pill that does not make you sleepy. Some people need more than the package says. This visit is for that next step. It is for adults 18 or older whom a clinician examined in person and diagnosed with chronic hives. That clinician also did a blood count and a blood test for inflammation (CRP or ESR), and you have the results. We do not order tests. The doctor reads your answers and your results and decides. If this visit is right for you, the doctor sends a written plan with one antihistamine every day. Step 1 is 2 times the label dose for 2 weeks. If you still have hives, step 2 is 4 times the label dose for 2 weeks. We never go higher than 4 times. Desloratadine (Clarinex) is different. It has no steps and stays at the label dose.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

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Already in ongoing care with us for this? Check-ins are $39 (your first one is free).

Quick facts

You must be physically located in Virginia or West Virginia at the time of request.
Starts at $59
No insurance needed
No app download
Physician review around the clock
Non-controlled prescriptions can be sent to your pharmacy when appropriate
A work or school note can be included when medically appropriate
Response times apply 24/7, every day

Common symptoms

Itchy, raised welts (hives) on the skin
Hives on most days for 6 weeks or longer, with no clear cause
Hives that are still there after 2 weeks or more of an antihistamine at the label dose

May fit online care

Adults 18 and older
You are 18 or older
A doctor, nurse practitioner, or physician assistant examined you in person in the last 12 months and said you have chronic hives
Your hives have lasted 6 weeks or longer, and you have them on most days
A blood count and a CRP or ESR blood test were done. You have the results. They were normal, and your clinician did not ask for more tests
You took one non-sedating antihistamine at the label dose (the dose on the package) for 2 weeks or more, and you still have hives
You have none of the warning signs below

Look for another care setting

Swelling of the lips, tongue, mouth, or throat (call 911 or go to the ER now).
Trouble breathing, wheezing, throat tightness, fainting, or severe dizziness (call 911 or go to the ER now).
Trouble swallowing or trouble speaking (call 911 or go to the ER now).
Widespread blistering, skin peeling, or sores in the mouth or eyes (call 911 or go to the ER now).
Fever with feeling very ill (call 911 or go to the ER now).
No urine at all, you cannot pass any (call 911 or go to the ER now, and stop your antihistamine).
New swelling of your face or eyelids together with hives, in the first 7 days after you started an antihistamine or raised its dose: Stop the medicine. Call 911 or go to the ER now.
A fever of 100.4 F (38 C) or higher (go to the ER or urgent care today).
A new medicine in the last 8 weeks, with a spreading rash or illness (go to the ER or urgent care today).
New swelling of your face or eyelids together with hives, not in the first 7 days after you started an antihistamine or raised its dose, and none of the signs above: Go to the ER or urgent care today. Keep taking your medicine. If you have trouble passing urine, stop it instead. Call 911 if you get swelling of the lips, tongue, mouth, or throat, a tight throat, wheezing, trouble breathing, swallowing, or speaking, or fainting or severe dizziness. Also call 911 if you get widespread blisters, skin peeling, or sores in the mouth or eyes, a fever with feeling very ill, or no urine at all.
Trouble passing urine (see a doctor in person today, and stop your antihistamine).
Hives that stay in the same spot for more than 24 hours (see a doctor in person within 7 days).
Hives that bruise or leave dark or purple marks (see a doctor in person within 7 days).
Hives that hurt or burn more than they itch, or that do not itch (see a doctor in person within 7 days).
Joint pain, joint swelling, or bone pain (see a doctor in person within 7 days).
Weight loss you cannot explain (see a doctor in person within 7 days).
Swelling of your face, eyelids, lips, hands, or feet at times when you have no hives (see a doctor in person within 7 days).
No in-person exam for your hives, a diagnosis made only by video, phone, or message, no diagnosis of chronic hives, or hives for less than 6 weeks (see a doctor in person within 7 days).
You take an ACE inhibitor, such as lisinopril, enalapril, benazepril, or ramipril (see your own doctor).
You were given an epinephrine injector because of your hives or swelling (see your own doctor).
You have kidney disease or liver disease (see your own doctor).
You use a shot or pill for hives from an allergist or skin doctor, such as Xolair, Dupixent, or Rhapsido (see your own doctor).
You are pregnant, might be pregnant, or are breastfeeding (see your own doctor).
You are under 18 (see your own doctor).
You get hives only after cold, heat, pressure, sun, water, exercise, or scratching (see your own doctor).
You were diagnosed more than 12 months ago (see your own doctor).
You do not have your blood count and CRP or ESR results, or the results were not normal, or your clinician wanted more tests (see your own doctor).
You have not taken one non-sedating antihistamine at the label dose for 2 weeks, or you take more than the label dose, or you take only a sleepy antihistamine (see your own doctor).
You have hives only on some days, not on most days, even if they bother you (see your own doctor).
Your hives are already gone or under control on the label dose, so you do not need a step-up (see your own doctor).
If more than one fits, follow the first one.

What to have ready

The clinic or clinician, and the date of your diagnosis
Your blood count and CRP or ESR results. A photo of the paperwork is fine
The antihistamine you take, how many tablets a day, and for how many weeks
Every medicine you take, including pain medicines

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer a few questions to check that this visit fits you, and choose how fast you want an answer (the response window). If your concern still fits this service, a physician reviews it and sends you a secure update after you sign in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

Your physician

Every visit is personally reviewed by Ankur Fadia, MD. He is board-certified, has extra training in heart care (a cardiology fellowship), and is a member of Alpha Omega Alpha, a medical honor society. He is licensed in Virginia and West Virginia, and your care is never handed off to someone else.

About Ankur Fadia, MD Verify Virginia medical license Verify West Virginia medical license Verify board certification

Can I take more than the package says?

Only as the doctor writes it. A dose above the label dose is called off-label. A guideline from allergy experts supports it, but the package says not to take more. For the medicine in your plan, follow our written plan. We never go higher than 4 times the label dose.

Do I need blood tests?

We do not order tests. You need the results of the blood count and the CRP or ESR test that your clinician already did. If you do not have them, or they were not normal, or your clinician wanted more tests, see your own doctor. A photo of the paperwork is fine. If we cannot see your results, we cannot send a medicine.

Which medicine will I get?

The doctor picks one: levocetirizine (by prescription), desloratadine (Clarinex) at the label dose only (by prescription), cetirizine (Zyrtec) from the store, or fexofenadine (Allegra) from the store. Take it every day, not only when hives show up. Do not mix two antihistamines. These medicines can make you sleepy, most of all at higher doses.

What if my hives last more than a day in one spot?

See a doctor in person within 7 days. Hives that stay in the same spot for more than 24 hours, that bruise or leave marks, or that hurt more than they itch can be a different problem that needs an exam.

What if I am still itchy after the highest step?

If your hives still bother you after 2 weeks at 4 times the label dose, see your own doctor and ask for an allergist. The same is true if hives still bother you after 2 weeks on desloratadine at the label dose. Allergists have other treatments. We do not start them here.

How do check-ins work?

The first check-in is free. It is about 2 weeks after you start. Each later fill follows another check-in. A check-in asks about the warning signs on this page again. There are no automatic refills. If your hives are gone for 12 weeks, the doctor may lower your dose in small steps. Do not stop the medicine all at once, unless a sign on this page says to stop it.

When should I get help right away?

Do not wait for our reply if a warning sign on this page starts. Our reply can take up to 6 hours. If more than one warning sign fits, follow the first one. Do not drive yourself to the ER.

Other conditions we treat

Not quite what you have? Here are other conditions we treat.

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