Urticaria, more commonly known as "hives" or "welts," is characterized by large, raised, round or irregularly shaped itchy, red lesions that can occur anywhere on the body. Many times the hives are accompanied by swelling, medically known as angioedema, which often affects the eyelids, lips, ears, hands or feet. The hives come and go, with each particular episode lasting less than 24 hours.
Acute urticaria is when the hives occur for six weeks or less, and is more likely due to allergies to certain foods, medications, insect stings or infections. Most cases of acute hives can be treated with antihistamines or a short course of oral steroids.
Chronic urticaria is when hives last for more than six weeks and sometimes can be a recurrent problem for years. Ninety-five percent of chronic hives are "idiopathic," meaning there is no known cause. The remaining 5 percent of chronic hives may be due to an underlying condition, such as a thyroid disorder, autoimmune problem, liver disease, chronic infection or, very rarely, cancer. Often, hives flare up with stress.
Last time I (Dr. Mangat) wrote an article on hives, I was suffering from chronic urticaria and trying to gain control of my hives.
I am happy to say that my hives are gone and have not recurred for the past 18 months.
I am also excited to report that the FDA recently approved a very effective treatment for chronic idiopathic urticaria: Xolair (or Omalizumab). The medication, which has been available for more than a decade and has been used in the treatment of asthma, has been approved for the treatment of chronic idiopathic urticaria in people older than 12 who have experienced minimal benefit with antihistamines.
The results have been dramatic, with some patients reporting relief in the first seven days. Many of the patients had complete resolution of their hives by 12 weeks. The medication is injected once every four weeks. The duration of treatment has not been established, but patients in research studies received the medication for 12 to 24 weeks. As with any medication, there may be side effects and risk involved, so it is best to speak to your allergist to see if this medication is right for you.
Hives can be an extremely frustrating condition for patients and doctors alike. Patients are often left feeling miserable with uncontrolled itching while the doctors have exhausted all possible therapies. It is a relief to know that there is now a medication that is effective and can dramatically improve the lives of those suffering with chronic hives.
Dr. Mona V. Mangat and Dr. Ami K. Degala are board-certified allergists and immunologists at Bay Area Allergy & Asthma in St. Petersburg. Find them at bayallergy.com.