New therapies available for chronic hives

Posted on February 10, 2020 by in Hives
 | Oak Street Medical

Two new therapies have virtually changed the way chronic hives are treated, providing much-need relief for those who suffer from this itchy condition.

Chronic hives, also called urticarial, is a condition that affects up to one percent of the population at any given time. It is defined as the recurrence of hives over six-weeks or longer. The most common cause is an autoimmune reaction generated by a person’s immune system. Read about what causes hives in a previous post, here.

Basic therapies include antihistamines, like Zyrtec, acid suppressors, such as Zantac that have antihistamine properties, or leukotriene modifiers. Some patients, however, do not respond to even high doses of these medicines. In these cases, short-term prednisone can be used. But long-term therapy with prednisone is problematic because of side effects that occur over time. But two new therapies, Cyclosporine and Xolair, are changing the game.

Cyclosporine is an immunosuppressant drug most commonly used in patients with an organ transplant. Cyclosporine calms the immune system enough to help prevent rejection. Because hives are most frequently an immune issue, cyclosporine helps prevent symptoms from occurring. Doses given to those with hives are typically much smaller than those for transplant patients; therefore, the risk of side effects is lower. Common side effects include nausea and headache. Patients can also develop high blood pressure or experience a decrease in kidney function, which means patients who take this drug should have blood pressure checks and kidney function labs drawn monthly. Response times can be as quick as a few days for patients.

Xolair, an injectable drug originally used to treat asthma, has also proven to be an effective hives remedy. It is administered to patients in the allergy office once a month, and patients normally find relief within a few days to a few weeks. It has a much lower potential for side effects than cyclosporine, yet less than 1 percent of the population can experience an allergic reaction, which means patients receiving it are asked to remain at the office for up to two hours following the first three injections. Beyond that, the wait time is 30 minutes. Xolair is expensive, so insurance company approval is a must. Before it was approved by the FDA to treat hives, insurance companies were unwilling to cover it. Since FDA approval, it has become much easier.

If you suffer from chronic hives, talk to your allergist about possible therapies, as we are now more able to resolve symptoms with minimal side effects.