Chronic hives make people miserable. They affect all facets of life — work, sleep, relationships, mood — and they can be relentless. Most folks who suffer from persistent hives can get adequate relief with simple, long-acting antihistamines like cetirizine (Zyrtec) or fexofenadine (Allegra) if taken in adequate doses (sometimes two to three times the usual daily dose). If these don’t work, then super-potent antihistamines like hydroxyzine or doxepin are the next step, but both are very sedating.
Sometimes even these very strong medications don’t work or the side effects are just intolerable. In the past, severe patients had very limited treatment options, usually potent immune suppressants like cyclosporine; but now there’s a new option in the form of a not-so-new medication: omalizumab (Xolair).
I’ve blogged about omalizumab a couple of times, and I gave a rundown of how it works way back in 2009. In simplest terms, it disarms the body’s allergy cells, making it nearly impossible for them to mount an allergic reaction. Because these cells are responsible in large part for causing hives, it makes sense that omalizumab would work in such cases, and now there are good studies to show that it is, indeed, effective when antihistamines fail.
So how effective is it? I would say moderately effective. Studies show that only about a third of folks who took omalizumab injections once a month got total relief and about two-thirds had a good response. It took up to two weeks to see improvement, and once they stopped taking omalizumab, the hives came back. On the good side, omalizumab is very well tolerated.
The important message here is this: you needn’t be miserable from chronic hives. Numerous good treatment options exist. To find which is most appropriate for you, go see your local board-certified allergist and get better.