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A new treatment for chronic hives


Written by Ronald Ragotzy, MD

If you have chronic hives—those itchy, painful red welts on your skin that seem to pop out of nowhere—you know how awful they can be and how unhappy they can make you. Fortunately, allergists now have a new medicine to treat chronic hives.

Hives can be caused by many things. This makes hives a challenge to cure or at least relieve. They are often a common allergic reaction to a substance, such as medicine. For instance, some people are allergic to penicillin. For them, the reaction to taking penicillin is an immediate case of hives. Easy to cure—stop the penicillin, stop the hives.

Note that hives can be more than an itchy nuisance. If large hives develop in your throat or your mouth, a condition called angioedema, they can block your airway. This requires emergency treatment.

Hives can also be related to hay fever, pet allergies, a wide variety of foods, sun exposure, emotional stress, exercise, or autoimmune diseases like lupus, MS, rheumatoid arthritis and type 1 diabetes. Sometimes, a cause is never found.

When hives become chronic (defined as lasting 6 weeks or more) and have no identifiable cause, the condition is called chronic idiopathic urticaria (CIU). To treat CIU, allergists turn to antihistamines such as Benadryl, Claritin, Zyrtec and others to relieve symptoms. If these alone don’t work, or work well enough, allergists may also prescribe H-2 antagonists (Tagamet, Zantac), oral corticosteroids (prednisone) or antidepressants (Zonalon).

Despite all these options, only about half of people with chronic hives find relief with them. For these folks, there is now a new prescription medicine available: Xolair. In March, Xolair (omalizumab) was approved by the Food and Drug Administration for the treatment of chronic idiopathic urticaria. Xolair is injected under the skin at an allergist’s office.

Since prescribing Xolair for my patients with chronic hives, I have found it to be a great treatment option. Even better, my patients are happy with the improvement in their condition and quality of life.

Ronald Ragozty, MD, is a board certified allergist and immunologist at the Mercy Clinic East in Janesville, (608) 756-7100, Mercy Beloit Medical Center, (608) 363-5500, and Mercy Walworth Hospital and Medical Center, (262) 245-0535.