Materiały źródłowe

• #1 Chronic hives – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-hives/diagnosis-treatment/drc-20352723

  To diagnose chronic hives, your healthcare professional will likely talk with you about your symptoms and look at your skin. […] An accurate diagnosis will guide your treatment. […] Treatment for chronic hives often starts with nonprescription anti-itch medicines, called antihistamines. If these don’t help, your healthcare professional might suggest that you try one or more prescription-strength medicines. […] For chronic hives that resist these treatments, your healthcare professional might prescribe a medicine that can calm an overactive immune system. […] Chronic hives can go on for months and years. They can interfere with sleep, work and other activities. […] Here are some tips to help you get ready for your appointment. […] What treatments are available, and which do you suggest? […] Do I need prescription medicine, or can I use nonprescription medicine to treat the condition? […] Your healthcare professional is likely to ask you a few questions, such as: […] What at-home treatments have you used?

• #2 Chronic Hives (Chronic Idiopathic Urticaria): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22900-chronic-hives-chronic-idiopathic-urticaria

  Chronic hives (chronic urticaria) are red, itchy skin welts that last more than six weeks. […] Antihistamines, steroids and immunosuppressants can soothe the hives. […] Treatments for chronic hives include: […] Allergy medications: Daily over-the-counter (OTC) or prescription allergy medications like antihistamines relieve itching and reduce or prevent allergic reactions. […] Steroids: Corticosteroids like prednisone (Deltasone, Rayos) can ease symptoms that don’t respond to allergy medicines. […] Hydroxychloroquine: A study found that 8 in 10 people with autoimmune disease-induced chronic hives got symptom relief after taking hydroxychloroquine (Plaquenil), an antimalarial drug, for three or more months. […] Cyclosporine: This immunosuppressant is highly effective at clearing up severe chronic hives. But it can cause serious side effects when taken for too long. […] For half of people with chronic hives, the hives go away (often without treatment) within a year. Treatments can ease symptoms of long-lasting hives. […] However, treatments like antihistamines, steroids and even immunosuppressants can help.

• #3 Chronic Spontaneous Urticaria – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://allergy.org.au/patients/skin-allergy/urticaria-hives-chronic

  Chronic spontaneous urticaria (CSU) is the name for hives (urticaria) that are chronic, lasting six weeks or more, three to four times per week, and have no known cause (spontaneous). […] The goal of treatment for chronic spontaneous urticaria (CSU) is to reduce or stop the itch and stop the hives developing with as few side effects as possible. Most cases of CSU will get better within a few weeks without any treatment but in some cases, they can last for many months or even longer. […] Common treatment options for CSU include: Non-drowsy antihistamines are often used to relieve the itch that comes with hives. Higher than standard doses may be required to achieve this for people with CSU. […] People with severe CSU symptoms affecting quality of life, who do not respond to simple treatments may need to be referred to a clinical immunology/allergy specialist. They will be assessed, and options for long term treatment discussed: Immune modulators usually given as subcutaneous (under the skin) injections that can be given at home. […] Immunosuppressive medications corticosteroids can be used to treat severe symptoms for a short time.

• #4 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Urticaria is caused by immunoglobulin E- and nonimmunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. The mainstay of treatment is avoidance of triggers, if identified. The first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses. […] In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine. More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within a year. […] Second-generation H1 antihistamines are safe and effective symptomatic therapy for urticaria. […] If needed to control symptoms of urticaria, second-generation H1 antihistamines can be titrated to two to four times the normal dose.

• #5 Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1078.html

  Urticaria involves intensely pruritic, raised wheals, with or without edema of the deeper cutis. […] Treatment includes avoidance of triggers, although these can be identified in only 10 to 20 percent of patients with chronic urticaria. First-line pharmacotherapy for acute and chronic urticaria is nonsedating second-generation antihistamines (histamine H1 blockers), which can be titrated to larger than standard doses. […] Nonsedating antihistamines are the first-line treatment of urticaria and may be titrated to two to four times their normal dose, if necessary. […] Second-generation antihistamines are considered first-line therapy. For better symptom control, the medication should be dosed daily, rather than on an as-needed basis. […] If symptoms remain uncontrolled, there are several options. The patient can be switched to a different second-generation H1 blocker and titrated as necessary.

• #6 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  HIVES TREATMENT […] Hives are treated with a combination of avoiding things that cause or worsen the hives, plus the use of medications. […] Avoiding triggers — The first treatment for hives is to figure out what is triggering your hives and then avoid that trigger. Even if you cannot figure out the trigger, hives usually disappear over days or weeks. […] Antihistamines — Antihistamines are medicines that can relieve itching. Most people with hives respond to antihistamines. You may need a relatively high dose to control your symptoms. […] There are different types of antihistamines. They differ in side effects, cost, how long the medicine lasts, and need for a prescription. […] Nonsedating antihistamines — Nonsedating antihistamines are generally preferred for treating hives because they have fewer side effects than older antihistamines. Also, these antihistamines have to be taken less often, usually once or twice per day. Many of them can be purchased over the counter, including:

• #7 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  Loratadine (sample brand name: Claritin) […] Cetirizine (sample brand name: Zyrtec) […] Fexofenadine (sample brand name: Allegra) […] Levocetirizine (sample brand name: Xyzal) […] Older antihistamines — Older antihistamines start to work quickly and work well to relieve symptoms. Some of them require a prescription, while others can be purchased over the counter. The problem with older antihistamines is that you have to take a dose four to six times per day, and many people have bothersome side effects. These can include drowsiness, dry mouth, double or blurred vision, or difficulty urinating. […] Some of these side effects interfere with driving and tasks requiring quick reactions, similar to the effects of drinking alcohol. These medicines are therefore not recommended for people who plan to drive, pilot aircrafts or boats, or operate heavy machinery or for people whose job performance may be otherwise affected. Starting the medicine at a low dose and gradually increasing the dose can help to ease side effects. The side effects usually get better if you take the medicine regularly over a period of days to weeks.

• #8 CHRONIC URTICARIA AND TREATMENT OPTIONS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2807703/

  Chronic urticaria has a wide spectrum of clinical presentations and causes. Still, despite our best efforts no cause may be found in the majority of cases. The treatment options are: Primary prevention in the form of avoidance of aggravating factors; counseling; antihistamines; leukotriene receptor antagonists; prednisolone; sulfasalazine and a host of immunosuppressives like methotrexate, cyclosporine, omalizumab etc. […] Treatment plan should include treatment of identifiable cause, avoidance of aggravating factors, advice and written information about the condition, and antihistamines trial. Topical lotions in form of calamine lotion, menthol with aqueous cream, and crotamiton lotion are useful soothing agents in the treatment. […] They are the first line treatment for all patients with CU. Classic H1 antihistamines with sedation as a side effect include chlorpheniramine, hydroxyzine, and diphenhydramine. Nonsedating second generation H1 antihistamines include loratadine, cetirizine, terfenadine, and mizolastine. Second generation H1 antihistamine derivatives include desloratadine, levocetirizine, and fexofenadine. H2 antihistamines include cimetidine, ranitidine, famotidine and nizatadine.

• #9 Update on the Treatment of Chronic Urticaria | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-update-on-treatment-chronic-urticaria-articulo-S1578219014001127

  The efficacy of the second-generation H1-antihistamines has also been demonstrated in the symptomatic treatment of urticaria. Some, such as rupatadine, have even been found to have greater affinity for binding to the histamine receptors than the first-generation H1-antihistamines. […] The antihistamines currently used for the treatment of CU are the first-generation H1-antihistamines, the second-generation H1-antihistamines, and the H2 antihistamines. […] The second-generation H1-antihistamines are currently the drugs of choice for the treatment of CU. However, symptoms persist in a large proportion of patients despite treatment with antihistamines at the recommended doses. […] In chronic autoimmune urticaria the cutaneous mast cells become permanently activated due to the presence of functional IgG antibodies to the alfa subunit of the FCRI (30%-50%) or to the IgE of the mast cell directly (5%-10%).

• #10 Evaluation, diagnosis and management of chronic urticaria

  https://www.racgp.org.au/afp/2014/september/evaluation-diagnosis-and-management-of-chronic-urt

  Chronic urticaria is characterised by the occurrence of weals, which occur on a daily basis for more than 6 weeks. […] Non-sedating histamine H1 receptor antagonists are the first-line treatment and are effective in 60% of patients. […] Histamine H1 receptor antagonists have been shown to reduce symptoms of hives and pruritus. These agents should be taken once daily. Not all patients will respond completely to H1 receptor antagonists. About 60% of patients with chronic urticaria respond to H1 receptor antagonists. […] First-generation H1 receptor antagonists, including hydroxyzine, diphenhydramine and cyproheptadine, can cause anticholinergic side effects and sedation. […] Second-generation H1 receptor antagonists, including cetirizine, loratadine, levocetirizine and desloratidine are equally effective and do not have the sedative and anticholinergic effects. For this reason they are the mainstay of treatment.

• #11 Acute Urticaria Treatment & Management: Approach Considerations, Pharmacologic Therapies, Nonpharmacologic Therapies

  https://emedicine.medscape.com/article/137362-treatment

  Second-generation H1-antihistamines are recommended as a first-line treatment for chronic urticaria. […] If the patient does not respond to this treatment, guidelines recommend increasing the dosage up to four times. […] Omalizumab is recommended for patients who remain unresponsive to antihistamines after the dose is increased. […] Ciclosporin is recommended for those who remain unresponsive to both antihistamines and omalizumab. […] The long-term use of systemic corticosteroids in chronic urticaria is not recommended, although a short course may be considered for patients with acute exacerbation of their symptoms. […] The EAACI/GA2LEN/EDF/WAO management guideline recommends the use of corticosteroids only in severely affected patients. […] A short course of an oral corticosteroid (administered daily for 5-7 d, with or without a taper) or a single dose of a long-acting injectable steroid is not usually associated with long-term sequelae and can be helpful when used for an acute episode of urticaria nonresponsive to antihistamines.

• #12 Chronic Urticaria Treatment & Management: Approach Considerations, Pharmacologic Therapy, Consultations

  https://emedicine.medscape.com/article/1050052-treatment

  Low-sedation antihistamines decrease the intensity of hives and pruritus in patients with mild chronic urticaria and are considered first-line therapy. […] Doubling the labeled dose of low-sedation antihistamines may benefit some patients, and increasing the dose of these antihistamines is often the safest therapeutic approach for patients who do not have an adequate response to the conventional doses of these medications. Increasing the dosage up to 4-fold is recommended by expert groups such as the European Academy of Allergy and Clinical Immunology (EAACI). […] As many as 75% of patients with chronic urticaria referred to tertiary care centers may require higher than conventional antihistamine doses. […] If high-dose nonsedating antihistamine therapy is not effective, switching to a different nonsedating antihistamine or adding a leukotriene antagonist to the antihistamine regimen may be considered.

• #12 Chronic Urticaria Treatment & Management: Approach Considerations, Pharmacologic Therapy, Consultations

  https://emedicine.medscape.com/article/1050052-treatment

  Nonsedating anti-H1 antihistamines remain the mainstay of treatment for chronic urticaria. If these agents are ineffective, higher dosages may be tried (up to four times the standard recommended dosage), or other agents may be substituted. Combined therapy with antihistamines or an immunosuppressive agent (eg, omalizumab, methotrexate) may be required. […] Elimination of suspected triggers should be advocated. Avoidance of mental stress, overtiredness, alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs), and tight-fitting garments is recommended. Psychological stress can trigger or increase itching. […] The mainstay of pharmacotherapy for chronic urticaria is the administration of low-sedation anti-H1 antihistamines (eg, loratadine, cetirizine, levocetirizine, and fexofenadine), which have a low incidence of adverse effects. Quality of life appears to be improved more by daily therapy than by therapy administered on an as needed basis.

• #13 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  The older antihistamines include: […] Diphenhydramine (sample brand name: Benadryl) […] Chlorpheniramine (sample brand name: Chlor-Trimeton) […] Cyproheptadine (sample brand name: Periactin) […] Other antihistamines — There is another type of antihistamine that is commonly used to treat heartburn. Your doctor or nurse might recommend one of these medicines in combination with another antihistamine if one medicine alone does not work for you. Examples of this type of antihistamine include: […] Famotidine (sample brand name: Pepcid) […] Cimetidine (sample brand name: Tagamet) […] Very sedating antihistamines — There are some very sedating antihistamines that are usually reserved for bedtime use. They can cause significant drowsiness and should not be taken when driving or working. They are sometimes helpful for getting a better night’s sleep when itching is severe. Some of these medications require a prescription. Examples include:

• #14 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  Hydroxyzine (sample brand names: Atarax, Vistaril) […] Doxepin (sample brand name: Silanor, Sinequan) […] Oral steroids — A high dose of antihistamines is usually recommended before trying other treatments. However, oral steroids (glucocorticoids), such as prednisone, can help to relieve severe acute hives that do not get better with antihistamines. Once the hives have improved, the steroid dose is gradually lowered and then stopped. […] Oral steroids may be used temporarily to relieve chronic hives, but they should not be used for long-term treatment. This is because steroids can have serious side effects when taken for long periods of time (months or years). If you are taking oral steroids for more than one month per year to control your hives, you should see a specialist (an allergist or a dermatologist).

• #15 Using Xolair® (omalizumab) For Chronic Hives Treatment

  https://www.xolair.com/chronic-spontaneous-urticaria.html

  For people 12 years of age and older with chronic spontaneous urticaria (CSU) not controlled by H1 antihistamines. […] If H1 antihistamines aren’t providing you with enough relief from itch and hives, XOLAIR may be an option. XOLAIR is the first FDA-approved biologic treatment for chronic hives with no known trigger. […] XOLAIR can help provide relief for itch and hives symptoms of CSU. […] XOLAIR targets IgE, which attaches to mast cells. Mast cells play an important role in CSU by releasing inflammatory substances, and inflammation is thought to play a role in CSU. […] XOLAIR is injected at home or in a doctors office on a monthly basis. […] XOLAIR (omalizumab) for subcutaneous use is an injectable prescription medicine used to treat chronic spontaneous urticaria (CSU, previously referred to as chronic idiopathic urticaria (CIU), chronic hives without a known cause) in people 12 years of age and older who continue to have hives that are not controlled with H1 antihistamine treatment.

• #16 Hives: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/hives-treatment

  When antihistamines fail to work, your dermatologist may prescribe this medication. It works throughout the body to calm your immune system, which can prevent your body from overreacting and producing hives. […] The FDA has approved omalizumab to treat a type of hives called chronic spontaneous urticaria in people 12 years of age and older who continue to get hives after taking antihistamines. […] If antihistamines fail to control hives, this may be an alternative treatment. Doxepin is an antidepressant medication that has strong antihistamine properties. It can be helpful for treating adults who have long-lasting hives. […] This medication can calm the immune system. By doing this, it can prevent new hives. Existing hives clear on their own. […] If your hives are caused by something physical like cold, heat, or pressure on your skin, your dermatologist may recommend this treatment. It involves exposing you to what is causing your hives, so that you no longer have flare-ups every time you encounter the cause. […] A treatment plan often works best when you follow these dermatologists at-home tips.

• #17 How Do You Treat Chronic Hives?Share to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on instagramFollow us on facebookFollow us on linkedincaret icon

  https://chronic-hives.com/treatment

  H1 antihistamines are the most common drug used to treat chronic hives. There are drowsy (first-generation) and non-drowsy (second-generation) versions. Doctors will start with non-drowsy H1 antihistamines, increasing the dose of a non-drowsy antihistamine up to 2-4 times the original dose, before suggesting drowsy versions. […] Oral steroids like prednisone can reduce swelling, redness, and itching. They should only be used for a short time to control symptoms during an episode. Taking long-term corticosteroids has a higher risk for side effects. […] When antihistamines do not control symptoms, your doctor may suggest taking omalizumab (Xolair). This is a biologic drug that blocks a protein involved in the allergic response, called immunoglobulin E (IgE). It is approved to treat people over age 12 with chronic hives that is not controlled with standard antihistamines. Xolair is given by injection under the skin (subcutaneously) every 4 weeks. About 65 percent of people who do not respond to antihistamines will respond well to omalizumab.

• #18 Using Xolair® (omalizumab) For Chronic Hives Treatment

  https://www.xolair.com/chronic-spontaneous-urticaria.html

  XOLAIR should be given by your healthcare provider in a healthcare setting. […] XOLAIR is given in 1 or more injections under the skin (subcutaneous), 1 time every 4 weeks. […] The most common side effects of XOLAIR in people with chronic spontaneous urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

• #19 CSU Chronic Hives Treatment | XOLAIR® (omalizumab)

  https://www.xolair.com/chronic-spontaneous-urticaria/about-chronic-hives/treating-chronic-hives.html

  When starting treatment, XOLAIR should be given by your healthcare provider in a healthcare setting. […] XOLAIR is given in 1 or more injections under the skin (subcutaneous), 1 time every 4 weeks. […] The most common side effects of XOLAIR in people with chronic spontaneous urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

• #20 Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1078.html

  A three- to 10-day tapered burst of oral corticosteroids (prednisone or prednisolone, up to 1 mg per kg per day) is sometimes used to get control of symptoms, although corticosteroids do not directly prevent mast cell degranulation, and long-term use is not recommended because of adverse effects. […] There are data on the effectiveness of leukotriene receptor antagonists such as montelukast (Singulair) and zafirlukast (Accolate) in the treatment of chronic idiopathic urticaria, especially in patients with cold urticaria or intolerance to nonsteroidal anti-inflammatory drugs, and a leukotriene receptor antagonist may be added if first-line agents are insufficient. […] If sufficient control still is not achieved, second-line agents including cyclosporine (Sandimmune), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), tacrolimus (Prograf), and dapsone have shown some benefits.

• #21 CHRONIC URTICARIA AND TREATMENT OPTIONS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2807703/

  Doxepin is the second line of treatment if antihistamines do not work. It is a tricyclic antidepressant. Dosage is 10-25 mg and may be increased to 50 mg. It works well when taken at night. […] Montelukast is a leukotriene receptor antagonist. It does not work in all types of urticaria. It works well for aspirin-sensitive urticaria. […] Prednisolone has predominant glucocorticoid activity and is commonly used for long-term disease suppression. […] Sulfasalazine is a long acting sulfonamide used in the treatment of ulcerative colitis, rheumatoid arthritis, and Crohn’s disease. It is reported to be useful in steroid-dependent CU. […] Methotrexate is the right choice in Indian setting where cost is an important factor in deciding the therapy. […] Cyclosporine is a powerful inhibitor of both cell mediated and humoral responses.

• #22 Evaluation, diagnosis and management of chronic urticaria

  https://www.racgp.org.au/afp/2014/september/evaluation-diagnosis-and-management-of-chronic-urt

  Histamine H2 receptor antagonists, including cimetidine, ranitidine and nizatidine, can be used in conjunction with H1 receptor antagonists. They are not generally used alone. […] Short-term use of corticosteroids is reserved for symptoms that are severe and cause significant pain and distress. […] Doxepin is a tricyclic antidepressant with potent H1 and H2 receptor antagonist activity. […] Narrowband ultraviolet B (NB-UVB) is used in a variety of skin ailments because of its anti-inflammatory and immunosuppressive properties. […] There are numerous reports in the literature detailing the efficacy of cyclosporine. […] Omalizumab is an anti-IgE monoclonal antibody, which has been shown to be beneficial in the treatment of chronic urticaria. […] Autologous serum is a promising treatment, which has been shown to be useful in the treatment of severe urticaria.

• #23 Treatment for Chronic Spontaneous Urticaria: What to Know

  https://www.healthline.com/health/treatment-for-chronic-spontaneous-urticaria

  Antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU). If antihistamines are unsuccessful, systemic therapies that suppress the immune system are the next option. […] Treatment for CSU focuses on reducing the body’s release of histamine and preventing the immune system from overactivity. […] The goals of treatment are to relieve itching and clear up the hives completely. Options for treatment include reducing exposure to triggers and taking medication. While medication can’t cure hives, it can help reduce the immediate symptoms. […] If antihistamines are not meeting your treatment goals for CSU, a doctor might recommend a leukotriene receptor antagonist (LRA). […] One tricyclic antidepressant called doxepin (Sinequan) blocks histamine release. Doctors sometimes prescribe this for CSU if antihistamines don’t work.

• #24 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  A short course of systemic corticosteroids may help control severe cases of urticaria. […] Current guidelines suggest a stepwise approach to treating chronic idiopathic urticaria. As with acute urticaria, the first step is second-generation H1 antihistamines. […] If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated, such as hydroxyzine or the tricyclic antidepressant doxepin. The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] For controlling flare-ups in chronic urticaria, a three- to 10-day burst of corticosteroids (prednisone or prednisolone up to 1 mg per kg per day) is sometimes used; long-term use is not recommended because of adverse effects.

• #25 Chronic Urticaria Treatment & Management: Approach Considerations, Pharmacologic Therapy, Consultations

  https://emedicine.medscape.com/article/1050052-treatment

  Systemic corticosteroids are usually effective when antihistamines are not adequate. In the rare situation where systemic corticosteroid treatment is needed to treat chronic urticaria, a low daily dose or alternate-day dosing is advised, and the dose should be titrated to the lowest effective level. […] Patients with autoimmune urticaria may benefit from administration of methotrexate or cyclosporine. […] Some patients with chronic urticaria and antithyroid antibodies benefit from levothyroxine treatment, perhaps because of suppression of thyroid activity and, possibly, the autoimmune process. […] Omalizumab (Xolair) was approved by the US Food and Drug Administration (FDA) in March 2014 for chronic idiopathic urticaria in adults and children aged 12 years or older who remain symptomatic despite anti-H1 antihistamine treatment. […] High-dose vitamin D add-on therapy may provide relief in some patients with chronic urticaria. […] AWBI may be an alternative to treat adults with refractory chronic urticaria.

• #26 Acute Urticaria Treatment & Management: Approach Considerations, Pharmacologic Therapies, Nonpharmacologic Therapies

  https://emedicine.medscape.com/article/137362-treatment

  Because of adverse effects of chronic or recurrent use of systemic corticosteroids, the long-term use of these agents should be avoided, when possible. […] Corticosteroids stabilize mast cell membranes and inhibit further histamine release, as well as reduce the inflammatory effect of histamine and other mediators. […] Omalizumab (monoclonal antibody to IgE) is a recombinant biologic molecule effective for chronic urticaria based on two large positive phase III studies and is currently FDA approved for treatment of chronic urticaria.

• #27 Update on the Treatment of Chronic Urticaria | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-update-on-treatment-chronic-urticaria-articulo-S1578219014001127

  CsA is an inhibitor of calcineurin, a protein with phosphatase activity that permits nuclear factor of T cells to pass from the cytoplasm into the nucleus, with expression of the IL-2 gene that activates T cells and stimulates the secretion of interferon- and GM-CSF. CsA therefore acts by blocking the synthesis of IL-2, giving rise to a state of cellular and humoral immunosuppression. […] Omalizumab is a humanized recombinant monoclonal antibody that binds specifically to the C3 domain of the IgE heavy chain, the site that binds to the high-affinity IgE receptors on the surface of mast cells and basophils. […] It has been observed that omalizumab is not only successful in the treatment of chronic autoimmune urticaria, but that it may also have a role in chronic idiopathic urticaria (ASST negative disease with no histamine release by basophils in vitro). […] The management and treatment of patients with CU is complex. For this reason, consensus guidelines based on scientific evidence and on expert opinion have been drawn up for the management of this disease.

• #28 Chronic spontaneous urticaria – Wikipedia

  https://en.wikipedia.org/wiki/Chronic_spontaneous_urticaria

  A two-pronged strategy has been proposed for the treatment of chronic spontaneous urticaria. First, the underlying cause(s) and/or eliciting trigger(s) must be established and eliminated. Pharmacotherapy is the second, and its goal is to relieve symptoms. Although removing the cause is the ideal course of action, this may not be feasible in many situations. […] According to current guidelines, a therapeutic approach should be implemented in three steps: (1) taking a second-generation antihistamine once daily; (2) increasing the daily dose of the second-generation antihistamine up to four times; and (3) pursuing off-label therapy with cyclosporine A or montelukast or add-on therapy with omalizumab, which is an approved treatment option for CSU. […] Omalizumab works well even in the most difficult, resistant situations. Despite having nearly as good of an efficacy as omalizumab, cyclosporine is regarded as third line because it carries a much higher risk of side effects. Long-term use of corticosteroids is not advised because the side effects increase with dosage and duration and eventually result in greater disability than CSU. However, until other treatments take effect, acute symptoms can be managed with a brief course of steroids.

• #29 CHRONIC URTICARIA AND TREATMENT OPTIONS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2807703/

  Omalizumab, a recombinant humanized monoclonal antibody against immunoglobulin IgE, represents a unique therapeutic approach for the treatment of allergic diseases. […] Bajaj et al., have used autologous serum therapy (AST) for two groups of patients with CIU (ASST-positive and ASST-negative) and found it to be an effective therapeutic modality to reduce disease severity as well as antihistamine requirement. […] Mycophenolate mofetil may be a valuable and safe treatment for patients with CU who do not respond to antihistamines and/or corticosteroids, and who require aggressive treatment to control their disease symptoms. […] In summary, methotrexate and autologous serum therapy are viable options in CU not responding to first and second line of treatments.

• #30 Therapies for Chronic Spontaneous Urticaria: Present and Future Developments

  https://www.mdpi.com/1424-8247/17/11/1499

  The international guidelines recommend treating patients until a complete clinical response is achieved. Currently, a three-step approach is suggested. The first step consists of using second-generation H1-antihistamines (sgAHs) at the licensed dosage. The second step involves increasing the use of sgAHs up to four times the licensed dosage. The third step consists of the addition of the anti-IgE monoclonal antibody, omalizumab. Although most patients with CSU achieve complete or partial control of the disease with stepwise treatment, some remain unresponsive. In such cases, switching to immunosuppressive therapy is suggested, with cyclosporine being the most studied and frequently prescribed option. Azathioprine, methotrexate (MTX) and mycophenolate mofetil (MMF) have also been proposed as alternative treatments. In the case of acute exacerbation, the guidelines suggest considering a short course of systemic glucocorticosteroids. Other therapies are being developed to target the pathomechanisms of CSU.

• #31 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  If antihistamines alone do not help your chronic hives, your doctor may recommend you combine it with other medications. […] Omalizumab (Xolair) is a biologic medication used to treat chronic hives. […] When chronic urticaria symptoms do not respond to antihistamines or omalizumab, then your doctor may recommend cyclosporine as the next step. […] Light therapy, also known as phototherapy, is a treatment option for very severe hives. […] The best treatment is the one that is most effective in reducing or eliminating hives and controlling the itch. […] Home remedies that can be used to treat hives include the following: Apply a cool cloth to the area of the hives or take a cool bath. […] Discuss any home remedies with your doctor first to make sure its safe for you. […] One way is to learn what triggers your chronic urticaria and try to avoid them.

• #32 Chronic Urticaria, Echinacea, Autohemotherapy

  https://worldallergy.org/component/content/article/chronic-urticaria-echinacea-autohemotherapy?catid=17&Itemid=101

  Currently, antihistamines are the mainstay of treatment for patients with chronic spontaneous urticaria (CSU). However, up to 40% of patients do not improve significantly even with high (four-fold) daily doses of modern antihistamines, requiring second-line therapies such as omalizumab and cyclosporine. […] Autohemotherapy, that is, injection of autologous whole blood or serum, is commonly used to treat patients with antihistamine-resistant CSU in several countries throughout the world such as China, Germany, India, Iran, South Korea, Turkey, Mexico, and the United States. Autohemotherapy might have rapid and persistent beneficial effects in patients with autoimmune CSU, related to a possible inhibitory action on autoantibodies. […] There is still insufficient evidence to broadly recommend the use of autohemotherapy as an effective treatment for CSU, added to the fact that its mechanism of action is not well understood.

• #33 Chronic Spontaneous Urticaria Treatment

  https://www.webmd.com/skin-problems-and-treatments/features/csu-meds-lifestyle

  Omalizumab targets immunoglobulin E (IgE), a protein that your immune system makes. […] One medical treatment that doesnt involve drugs is narrow-band ultraviolet light therapy, also known as phototherapy. […] Beyond taking medications, one of the best things you can do when it comes to managing CSU is to avoid anything that seems to set off a flare. […] People with CSU often dont want to be on medications for months or years, especially because of the side effects and risks. […] There is some evidence that other therapies may be helpful in treating the symptoms of CSU. […] Acupuncture therapy is a common treatment for CSU in Asia. […] If stress is a trigger for you, try adding relaxation techniques into your day to help you unwind and calm down. […] Some research shows that vitamin D supplements could help CSU. […] Sink recommends support groups as a great resource for people with CSU. […] CSU can be stressful due to its unpredictable nature, lack of a clearly identifiable trigger, and disruption of work, school, and sleep.

• #34 New treatments for chronic urticaria – PubMed

  https://pubmed.ncbi.nlm.nih.gov/31446134/

  Chronic urticaria (CU) is a common, heterogeneous, and debilitating disease. Antihistamines and omalizumab are the mainstay therapies of CU. Additional treatment options are needed. […] Omalizumab, the treatment of choice in patients with antihistamine-resistant chronic spontaneous urticaria (CSU), should be explored for use in chronic inducible urticaria in children younger than 12 years with CSU and at higher doses. The off-label use of dupilumab, reslizumab, mepolizumab, and benralizumab can be effective in CU. Ligelizumab and UB-221, 2 novel anti-IgE monoclonal antibodies, are in clinical trials for CU. Other promising drugs that are currently under development for CU are a chemoattractant receptor-homologous molecule expressed on TH2 cell antagonist, a monoclonal antibody to Siglec-8 (AK002), Bruton tyrosine kinase inhibitors (fenebrutinib and Lou064), a spleen tyrosine kinase inhibitor, and dupilumab. Promising targets of future therapies include the Mas-related G-protein-coupled receptor X2; the histamine4 receptor; C5a and its receptor; inhibitory mast cell receptors other than Siglec-8; interleukin 33, interleukin 25, and thymic stromal lymphopoietin, and stem cell factor. […] Novel and better treatments for CU are very much needed. Some agents are in clinical trials already (eg, ligelizumab), and additional ones should be developed, making use of the many promising targets recently identified and characterized.

• #35

  https://link.springer.com/article/10.1007/s40265-025-02170-4

  Chronic spontaneous urticaria (CSU) is a mast cell-mediated skin disease that presents with wheals, angioedema, or both for more than 6 weeks. Less than 10% of patients have complete control of their CSU (the main goal of CSU treatment) with second generation H1-antihistamines, the first-line treatment. About 70% of patients with antihistamine-refractory CSU do not reach complete control with omalizumab, the second-line treatment. Novel therapies are especially needed for patients with mast cell-activating immunoglobulin (Ig)G autoantibodies (autoimmune CSU) associated with nonresponse or late response to omalizumab. Furthermore, there is a lack of disease-modifying treatments that induce long-term CSU remission after drug withdrawal. Several emerging treatments can address these unmet needs including Bruton tyrosine kinase inhibitors, e.g., remibrutinib and rilzabrutinib; anti-KIT monoclonal antibodies, e.g., barzolvolimab; and anti-cytokine therapies, e.g., dupilumab. In clinical trials, 30-31%, 28-32%, and 38-51% of patients with CSU showed complete response to treatment with dupilumab (phase 3, week 24), remibrutinib (phase 3, week 24), and barzolvolimab (phase 2, week 12), respectively. The most common adverse events were injection site reactions for dupilumab (12%), respiratory tract infections (11%), headache (6%), and petechiae (4%) for remibrutinib and changes in hair color (14%), neutropenia / decreased neutrophil count (9%) and skin hypopigmentation (1%) for barzolvolimab. This review provides an update on the current state of development of treatments for CSU.

• #36

  https://link.springer.com/article/10.1007/s40265-025-02170-4

  Chronic spontaneous urticaria is a difficult-to-treat disease, with many patients failing to achieve complete disease control with second-generation H1-antihistamines and the anti-IgE antibody omalizumab. […] Remibrutinib, a Bruton tyrosine kinase inhibitor, and the anti-IL-4R antibody dupilumab are effective and safe for treating chronic spontaneous urticaria and are expected to receive approval for this indication. […] Other promising treatments in development for CSU include anti-KIT antibodies, e.g., barzolvolimab, JAK inhibitors, and MRGPRX2 antagonists.

• #37 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  Chronic urticaria is a rare condition. More than 500,000 people live with chronic urticaria in the United States. It occurs in 0.23% (or 23 out of every 10,000) of people. However, there are estimates that rates of chronic urticaria may be higher since many times people do not report or recognize symptoms. […] Chronic urticaria is not a life-long condition; it usually goes away by itself over a period of weeks, months or even years. […] The first line of treatment for most cases of chronic urticaria is a long-lasting antihistamine. Its best to create a treatment plan with your allergist, dermatologist or primary care doctor. […] Chronic urticaria international guidelines recommend a step-based approach to treatment. […] Antihistamines block the production of histamine. They can reduce or eliminate your hives and help ease symptoms of itch and swelling.

• #38 Chronic Hives Treatment

  https://allergylosangeles.com/allergy-blog/stepwise-approach-to-chronic-urticaria/

  Chronic hives is associated with poor sleep and reduced quality of life. […] Recent stepwise guidelines were published by the Annals of Asthma, Allergy and Immunology regarding the treatment of Chronic Urticaria (chronic hives). […] Step 1– Nonsedating second or third generation antihistamines taken up to 4 times a day. (i.e. Claritin, Zyrtec, Allegra, Xyzal, Clarinex) Decrease the dose as tolerated. […] Step 2– Omalizumab 300 mg monthly (Xolair). If no response after 3 injections, (some studies say up to 6 injections) proceed to step 3. […] Step 3– Cyclosporine, 200-300mg a day. […] Step 4-Options to consider are dapsone, methotrexate, colchicine, sulfasalazine, hydroxychloroquine, IVIG and plasmapheresis. […] Step 5- If all options fail, low dose, long term corticosteroids may be considered for chronic hives.

• #39 Chronic urticaria

  https://dermnetnz.org/topics/chronic-urticaria

  Chronic urticaria is defined as daily itchy wealing of the skin for more than six weeks. […] The main treatment for chronic urticaria in adults and children is with an oral second-generation H1-antihistamines such as cetirizine or loratidine. If the standard dose (eg, 10 mg for cetirizine) is not effective, the dose can be increased fourfold (eg, 40 mg cetirizine daily). […] Identifiable triggers for urticaria should be avoided where possible. […] Patients with chronic urticaria that has failed to respond to maximum-dose second-generation oral antihistamines taken for four weeks should be referred to a dermatologist, immunologist, or medical allergy specialist. […] Omalizumab is now regarded as the treatment of choice for antihistamine-resistant patients. […] Long-term systemic corticosteroids are not generally recommended, as high doses are often required to control symptoms of urticaria and they have inevitable adverse effects that can be serious.

• #40 Hives and angioedema – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hives-and-angioedema/diagnosis-treatment/drc-20354914

  For a severe attack of hives or angioedema, you may need a trip to the emergency room and an emergency injection of epinephrine a type of adrenaline. If you have had a serious attack or your attacks recur despite treatment, your doctor may have you carry a penlike device that will allow you to self-inject epinephrine in emergencies. […] If you’re experiencing mild hives or angioedema, these tips may help relieve your symptoms: […] A nonprescription oral antihistamine, such as loratadine (Alavert, Claritin, others), cetirizine (Zyrtec Allergy, others) or diphenhydramine (Benadryl Allergy, others), may help relieve itching. […] For hives and angioedema, questions you may want to ask include: […] Do I need prescription medication, or can I use nonprescription medications to treat the condition? […] What are the alternatives to the primary approach that you’re suggesting?

• #41 Hives (urticaria): Causes, pictures, and treatments

  https://www.medicalnewstoday.com/articles/157260

  The best approach to treatment depends on the cause and whether the issue is acute or chronic. […] A person with chronic urticaria may need to take antihistamines regularly until their symptoms resolve. […] Omalizumab (Xolair) is an injectable drug that blocks immunoglobulin E, a substance that plays a role in allergic responses. It can reduce symptoms of chronic spontaneous urticaria, a type of hives with an unknown origin. […] If tests reveal an underlying disease, such as lupus, the doctor will recommend treatment for this. […] Tips for reducing hives symptoms include: using a soothing lotion or cool compress to ease the itchiness, wearing loose, light, cotton clothing, avoiding scratching, choosing soaps, moisturizers, and other cosmetics for sensitive skin, avoiding exposure to known triggers.

• #42 5 Ways to Treat Your Chronic Hives: Catherine Fuller, MD: Allergy, Asthma, & Immunology Specialists

  https://www.drfullerallergy.com/blog/5-ways-to-treat-your-chronic-hives

  Chronic hive treatment usually begins with over-the-counter (OTC) anti-itch medications or antihistamines. If OTC antihistamines dont deliver sufficient relief, prescription antihistamines that dont cause drowsiness may be more effective. […] When persistent hives dont respond to daily antihistamine treatment, a monthly injection of a medication called omalizumab (Xolair) is often the next best step. […] Oral corticosteroids like prednisone alter immune system function to reduce skin redness, swelling, and itching caused by chronic hives. These steroidal medications often work when allergy medicines dont. […] When hive flare-ups occur, there are several ways to relieve the constant itch, redness, and swelling they cause. […] High-stress levels or anxiety can trigger or worsen many skin conditions, including chronic hives. If you frequently feel stressed or anxious, look for healthy ways to calm your nerves and emotions. […] If youre dealing with chronic hives, Dr. Fuller can help you rule out possible causes, including serious health problems. And even without verified causes or triggers, she can provide an individually tailored treatment plan to help you attain long-lasting relief.

• #43 Chronic Hives: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.chronic-hives-care-instructions.uf7064

  Chronic hives are long-lasting raised, red, and itchy patches of skin. […] When hives and swelling last more than 6 weeks even with treatment, they are called chronic. […] Your doctor may suggest a nondrowsy antihistamine, such as loratadine (Claritin), to help control the hives. […] Your doctor may prescribe a shot of epinephrine to carry with you in case you have a severe reaction. […] If your doctor prescribes another medicine, take it exactly as directed. […] Call your doctor now or seek immediate medical care if: Your hives get worse. […] Watch closely for changes in your health, and be sure to contact your doctor if: You do not get better as expected.

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