No More Itching 

Recent FDA approval signals relief for hives sufferers

by Marek M. Pienkowski, M.D., Ph.D.

Everyone experiences at some point in life episodes of itching, swelling and redness on the skin, also known as “hives” or “urticaria.” For those with persistent urticaria, there is now new hope – Xolair.  Hives can occur as a result of the body’s reaction to certain allergens such as pollens, animals and dust mites. Hives can also occur as the result of the consumption of foods or medications, such as aspirin or morphine (or their derivatives), or ACE inhibitors (which lower blood pressure).  In some people, hives can also be precipitated by strenuous exercise, exposure to cold temperatures or by an autoimmune condition.

Hives (or “urticaria”) can last a few minutes to several hours and can be confined to any part of the body and sometimes coalesce together.  They can appear as small red wheals or patches with many shapes, surrounded by a red flare and can be very itchy.

In the majority of cases, hives disappear spontaneously within hours without any treatment.  However, in some individuals, they can persist for weeks or months.  This is known as “chronic hives” or “chronic urticaria.”  This condition can be quite debilitating and typically requires medical evaluation to determine the etiology of the condition.  Typically, this evaluation is done by an allergy and immunology physician who performs a battery of tests including, but not limited to, blood tests (to address conditions such as hepatitis, lupus or thyroid disease) and allergy skin tests (to find specific triggers).  On occasion, it will be necessary to perform skin biopsy to rule out conditions such as vasculitis (inflammation of the blood vessels).

One of the most critical components of the evaluation by the physician is an in-depth medical history of the presentation of the recurrent hives associated with activities, diet, medications, etc, followed by a thorough physical examination.

In the majority of cases, hives disappear spontaneously within hours without any treatment. However, in some individuals, they can persist for weeks or months.

Medical treatments for individuals with chronic urticaria include first generation oral antihistamines like Benadryl and second generation antihistamines like fexofenadine, levocetirizine or desloratadine.  If the problem still does not resolve, the physician will consider an H2-receptor antagonist like Tagamet, which blocks the action of histamines; oral steroids like prednisone; leukotriene modifiers like Singulair, which inhibit compounds that cause inflammation; or immunosuppressants like Cyclosporine.  Unfortunately, all medications can be associated with multiple side effects.  Also, sometimes despite all efforts, some individuals still continue to have recurrent episodes of the severe chronic hives.

In the last week, the FDA released approval for the medication: Omalizumab (also known as Xolair) to help adults and adolescents (above the age of 12) with chronic idiopathic (unknown source) urticaria.  Previously, Xolair has been used to treat severe and persistent allergic asthma with excellent results.  New research has demonstrated that Xolair is also very effective in treating chronic urticaria. This treatment involves just once per month subcutaneous injection of the medication.  Although very safe, there is still risk of anaphylaxis, and so the treatment is limited to use only by specialized physicians.

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Marek M. Pienkowski, M.D., Ph.D. was educated in clinical immunology at Johns Hopkins School of Medicine in Baltimore and internal medicine at Henry Ford Hospital in Detroit. Dr. Pienkowski has been serving patients in East Tennessee with allergies, asthma and immunological disorders for nearly 30 years through Allergic Diseases, Asthma & Immunology Clinic, P.C.. Active both in biomedical research and academia, he has published more than sixty scientific papers as well as two books.