New treatment option gives hope to patient with hives

Have you ever had uncontrollable itching? Imagine an unrelenting itch over your entire body lasting for months or even years! This alone would be miserable, but add a widespread rash, swelling of your lips, and eyelids and you have the diagnosis of chronic urticaria. 


For many years, patients with urticaria, colloquially hives, have struggled to find relief for their symptoms. They often suffer from recurrent, unexpected breakouts of red, itchy welts that cover their body from head to toe. In more severe cases, this can progress to involve significant swelling of the skin leading to disfiguring and painful episodes. These people can suffer from anxiety, depression, social isolation, poor sleep at night and decreased performance of daily activities.

While some people are more prone to hives than others, we do not have a clear understanding of why. In the majority of cases, isolated episodes of hives are caused by viral infections. In other cases, they can be due to allergies to foods, medications, latex, or insect stings and normally appear within a short period of time — approximately two hours — after exposure. Recurring and ongoing episodes of hives are rarely caused by allergic triggers and frequently are due to an autoimmune phenomenon. High levels of stress can worsen hives, and for some patients physical triggers like exercise, heat or pressure can also trigger symptoms. In very rare cases, it can also be an indicator of an autoimmune disorder or problems with your thyroid or liver.

People with hives often struggle to find a therapy that can provide relief. They try using anti-histamines like Benadryl, but its short duration and high sedation potential make it a poor therapy for these patients. Those with mild hives will often respond to the long-acting, less-sedating antihistamines such as cetirizine or fexofenadine. Those with more severe or frequent outbreaks often relied on oral steroids for suppression and accept the long-term side effects that may come with this option. Over the years, the difficulty in finding medications to successfully control symptoms has led many people to use medications initially intended for chemotherapy. This has led the medical community to look for less toxic alternatives for patients.

A new hope has appeared for these often desperate patients. In April 2014, the FDA approved Xolair, or omalizumab, for use in the treatment of chronic urticaria. The discovery of this medication’s benefits for the treatment of chronic hives was both unexpected and fortuitous. It had been used for the treatment of uncontrolled allergic asthma for over a decade when patients who also had hives began to notice an astonishing improvement in their skin symptoms. Controlled research studies were quickly launched, and confirmed the sometimes miraculous benefits of the medication. Patients with years of hives often improved dramatically with only a single dose.

Xolair is administered to patients as a once-a-month injection under the skin. It does not require an IV. Compared to medications such as oral steroids, its side effects are dramatically less with a small risk of an allergic reaction, the only adverse effect of significant concern. However, it is because of this risk that the medication is required to be administered in a physician’s office under the guidance of a specialist experienced in its use.

Xolair’s higher cost is because it’s one of a group of cutting-edge medications known as monoclonal antibodies that have been revolutionizing the treatment of medical conditions in oncology, rheumatology and now allergies. Although it is an expensive medication, the cost to the patient is usually reasonable, thanks to a combination of insurance coverage plus aggressive patient assistance programs sponsored by the manufacturer.

The emergence of Xolair over the past few years has been a life-changer for many patients with chronic refractory urticaria. While hives are not usually dangerous, they can be extremely distressing due to constant, uncontrollable itching and disfiguring welts. Patients with hives have long suffered from a variety of social and psychiatric issues due to this difficult condition. Today, controlling and possibly curing this chronic condition is closer than ever before!