Options Emerge for Chronic Hives

A diagnosis of chronic hives is made when hives reoccur frequently for 6 weeks or more. The red, itchy, raised welts are visually bothersome and itch severely. Many times they are also accompanied by angioedema, or swelling around the eyes, lips or other areas of the face. Because of the itching and swelling, hives often have a dramatic impact on sleep, confidence and overall quality of life.

When high dose antihistamines, such as Zyrtec or Allegra fail, the standard has been to move to a medication called Xolair. In chronic hives, a special cell called a mast cell starts to release histamine, causing inflammation. Xolair works by binding to a substance called IgE, and when this occurs the IgE can not move into its “parking spot” or binding site on the mast cells, therefore preventing the release of histamine. In this way, Xolair works to reduce and often eliminate chronic hives. Xolair is given as an injection into the fatty (subcutaneous) tissue once a month.

Xolair has been the standard since 2014 with over 380,000 patients having used it to control their hives (Genetech USA, Inc. South San Fransicso, CA, data current as of December 2024). However,  this April a medication called Dupixent became FDA approved for chronic hives as well. Dupixent itself is not a new medication. It came to the market in 2017 for treatment of moderate to severe eczema. However, since then research has found Dupixent works on a variety of inflammatory disorders. The mechanism of action of Dupixent is different than the action of Xolair, giving another option for those who maybe are not the right fit for xolair or did not see complete control on xolair. Dupixent works by targeting IL4 and IL13, 2 pathways that are responsible for cells that can create inflammation. When Dupixent works at these pathways, we see improvement of inflammation and therefore, the hives. Dupixent is typically administered at home as an injection into the fatty (subcutaneous) tissue every 2 weeks.

If you have more than one inflammatory disorder such as hives and eczema, this may guide which biologic would be the best choice for you. Dupixent is FDA approved for asthma, eczema, eosinophilic esophagitis, prurigo nodularis, nasal polyps and COPD with eosinophilic phenotype. Xolair also has FDA approval for food allergy, asthma, and nasal polyps.

In the end, for those suffering from  hives, the FDA approval of Dupixent is very exciting as it allows for options for those who need to control their chronic hives.

If you are struggling with chronic hives, we would love to discuss your treatment options with you, including Xolair or Dupixent. Make an appointment today.