Injectable Medications for Chronic Hives

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Many people develop the itchy, red welts known as hives at some point during their lives, but a smaller subset of this group will have hives that persist longer than six weeks. Even more troubling, about 95% of those with long-lasting hives are unable to identify what causes them, like an allergic reaction or a virus. This condition is called chronic idiopathic urticaria and finding a treatment that works can be a challenge. It’s important to see a specialist to treat chronic hives–either a dermatologist or an allergist. If standard first-line treatments aren’t successful, your doctor may suggest trying an injection to treat your chronic hives.

Finding the best treatment for hives is a step by step process.

If you have chronic hives, it’s not uncommon to require a few different medications to control your symptoms. It can take a bit of trial and error to discover what works best. Your doctor will start with the most common treatments and adjust as needed from there.

Hives develop when a reaction occurs in your body, stimulating your skin to release a chemical called histamine. For this reason, antihistamine medications are usually tried first. These include over-the-counter drugs like cimetidine (Tagamet HB) and ranitidine (Zantac). Your doctor may prescribe higher doses of antihistamines if you don’t respond.

Another class of medication called leukotriene modifiers, which are often used to treat asthma, may be added to your medication regime as well. Examples include montelukast (Singulair) and zafirlukast (Accolate).

If these medications fail to improve your chronic hives, your doctor may consider trying alternative medications, including an injection called omalizumab (Xolair).

An injection for hives may help treat chronic idiopathic urticaria.

In 2014, the U.S. Food and Drug Administration (FDA) approved omalizumab as a treatment for chronic hives. This medication, which was previously used to treat allergic asthma, seems to decrease the release of histamine in your body. Many people experience notable improvements quickly, lowering both the number of hives and the intensity of itching. In some cases, hives may completely clear.

Omalizumab is given as an injection under your skin. It’s administered in a doctor’s office once a month. It’s generally well-tolerated, but there is a slight risk of having a severe allergic reaction. Your doctor should prescribe an epinephrine auto-injector (Epipen, Auvi-Q) for you to have at home in case of a reaction.

Omalizumab is part of class of medications known as biologics. Because of its success in treating chronic hives, other biologics are currently being studied as possible future therapies, including:

  • Intravenous immunoglobulin (IVIG)

  • Rituximab (Rituxin)

  • Tumor necrosis factor (TNF) inhibitors, such as etanercept (Enbrel) and infliximab (Remicade)

These biologic drugs are given as an injection or an infusion into a vein. They interact with vital pathways that control your immune system and your body’s inflammatory response. More research is needed to determine their safety and effectiveness in treating chronic hives.

Let your doctor know if your chronic hives treatment isn’t working.

The discomfort caused by chronic hives can impact your daily life, so it’s important to talk to your doctor if your current medications aren’t bringing you relief. In addition to the options already discussed, your doctor may try you on an immunosuppressant like cyclosporine. Corticosteroids, such as prednisone, can also be used for their anti-inflammatory effects but are usually only given for a short duration. The best thing to do is stay open and honest with your doctor about your experience with hives and the treatments. Together, you will find a solution that offers you relief.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Feb 14
  1. Chronic Hives. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719
  2. Chronic Spontaneous Urticaria: Treatment of Refractory
    Symptoms. UpToDate. https://www.uptodate.com/contents/chronic-spontaneous-urticaria-treatment-of-refractory-symptoms
  3. The Expanding Field of Biologics in the Management of
    Chronic Urticaria. The Journal of Allergy and Clinical Immunology: In Practice.
    https://www.jaci-inpractice.org/article/S2213-2198(17)30380-X/fulltext
  4. Urticaria. American
    Osteopathic College of Dermatology. https://www.aocd.org/page/Urticaria
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