Chronic spontaneous urticaria (CSU), hives (urticaria) that lasts 6 weeks or longer (chronic) and has an unknown cause (spontaneous), can have a significant impact on your life. The itchy hives can make you feel self-conscious. They can make it difficult to sleep and lead to fatigue. They can be irritable and depressed, leading to problems in relationships and at work. They can cause severe swelling of the lips, eyelids, hands, feet, and other areas of the body. And if you scratch it, you could damage the skin, which could lead to infection. So what can you do against the CSU?
Find the right healthcare provider
If you develop hives, general practitioners are usually your first port of call. However, if these do not respond to treatment, it is time to request a referral to a specialist – an allergist or a dermatologist. Allergists can perform tests to rule out allergies or autoimmune diseases. They are also the most up-to-date information on the different types of antihistamines and other advanced medications used in the treatment of allergies. Dermatologists, on the other hand, have experience prescribing immunosuppressive treatments, medications that weaken the immune system’s response, for many types of skin conditions.
Preparing for appointments for the treatment of chronic spontaneous urticaria
No matter which specialist you see, it’s important to be prepared for your appointments so you don’t leave and then realize there are things you didn’t discuss.
Track your symptoms: Using a calendar or diary app, or on paper, track when your hives come and go, where they occur, how long they last, and what triggers may have caused them. Describe the symptoms clearly and indicate whether treatment seemed to improve them.
Track your quality of life: As important as it is to track your hives, it is also important that you track how they are affecting you. You can show your healthcare provider (HCP) how the itching keeps you awake, for example, causing you to miss work or cause anxiety.
Always bring a list of medications with you to your appointments: You can either bring your own medication list (including supplements, vitamins, and over-the-counter skin creams) or ask your pharmacist to print out your most recent medications.
Bring a list of questions: Before your first appointment and between appointments, keep a running list of questions so you remember to ask them.
Treatment of chronic spontaneous urticaria
Because CSU is not caused by a specific allergy or external trigger, it does not always respond to the same treatments as regular hives. CSU is thought to be caused by an overactive immune system, meaning treatments may need to target more than just the itchy hives. There are different types of medications that healthcare professionals can use to treat CSU. However, you may need to try different medications to find what works for you. One of the questions you should ask your doctor when trying a new medication is: “How long will it take to see the effects of the medication?” This way you know how long you have to wait and don’t get discouraged if it doesn’t work right away. You will also learn if the medication is not working for you and if you need to try another option.
Treatment options for hives
Antihistamines
Antihistamines are usually the first treatment tried for CSU. Some antihistamines can be purchased over the counter, but others require a prescription. Antihistamines commonly used for CSU include:
- Cetirizine (Zyrtec)
- Desloratadine (Clarinex)
- Fexofenadine (Allegra)
- Levocetirizine (Xyzal)
- Loratadine (Claritin)
When these medications work, they often take effect within a few days or weeks, sometimes after just a single dose.
Steroids
Corticosteroids such as prednisone or prednisolone, which are oral tablets, can help control inflammation, which can reduce severe flare-ups. However, they are a short-term solution and do not address the problem that caused the hives in the first place. These medications are not used for long-term treatment because of the risk of serious side effects. Steroids in creams or other preparations applied to the skin do not work for CSU.
Medicines for asthma, allergies and eczema
Researchers found that some medications typically used to treat asthma, allergies or eczema may help treat CSU symptoms in people who don’t get relief from other medications. Montelukast (Singulair) is one. It belongs to the leukotriene receptor antagonist family of active ingredients. Your doctor might recommend it along with antihistamines. There isn’t much research into how long it might take to take effect, but some case studies showed that some patients responded within a few weeks.
Dupilumab (Dupixent) and omalizumab (Xolair and Omlyclo) are biologics approved for the treatment of CSU and are administered as a monthly injection. For some people taking these medications, symptoms resolve within a few weeks, but for others it may take longer.
Immunosuppressants
Immunosuppressants help treat diseases that cause your body to attack itself. They are used for many diseases such as multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis. Some immunosuppressants may help with CSU, including:
- Acalabrutinib (Calquence)
- Azathioprine (Imuran)
- Cyclosporine (Gengraf, Neoral and Sandimmune)
- Hydroxychloroquine (Plaquenil)
- Methotrexate
- Mizorbinate
- Mycophenolate mofetil
- Tacrolimus
Some patients notice improvement within weeks, while others may take months.
This educational resource was created with support from Regeneron and Sanofi.
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