What are your treatment options for severe urticaria/hives?

See Allergist. There are a number of treatment options for severe, refractory hives. First line is high dose non-sedating antihistamines like Zyrtec followed by H2 blockers like Zantac (ranitidine). Montelukast can also be used as well as sedating antihistamines like hydroxyzine or doxepin. If these therapies fail there are more aggressive treatments like omalizumab, anti-inflammatories, and immunosuppressants. See Allergist.