Understanding chronic urticaria (hives) and how to treat it
One of the most frustrating skin conditions to have (and treat) is chronic urticaria. Urticaria, commonly known as hives, can be classified as either acute (an episode lasting less than 6 weeks) or chronic (symptoms daily or almost daily for more than 6 weeks). Specific triggers (e.g. pressure, cold) may induce symptoms of urticaria, but often there is no specific external trigger for chronic urticaria. In Canada and the U.S. this chronic condition is labeled Chronic Idiopathic Urticaria (CIU) while the rest of the world refers to it as Chronic Spontaneous Urticaria (CSU). Despite the different terminology it is the same disease.
It is estimated that CIU affects up to 1% of the population at any given time, with peak incidence in patients between 20-40 years of age. CIU generally persists in patients for 1-5 years, with 50% of cases resolving within 6 months of onset and only about 5% lasting more than 10 years.
One of the most serious adverse effects of CIU is impairment of quality of life. Diagnosis and treatment is key to helping improve quality of life for patients.
The diagnosis of CIU is a two-step process. The first step is to gather relevant history from the patient regarding time of disease onset and frequency / duration of symptoms. The second step is a physical examination and diagnostic provocation test. Following diagnosis, your doctor will likely assess the severity using the Urticaria Activity Score (UAS), looking at the number of hives and itch intensity over a 7-day period (UAS7).
The goal in treating CIU is rapid and complete symptom control. The first line of treatment is the use of H1 antihistamines. These are over the counter drugs like Claritin, Allegra and Aerius. If symptoms persist after two weeks the second line treatment is to increase the dosage of antihistamines up to four times. If symptoms are still unresolved then third line treatments include cyclosporine and montelukast (Singulair). Most recently omalizumab (Xolair) was added to the treatment arsenal.
Omalizumab was approved in Canada for treatment of moderate to severe CIU in August 2014, following approval in the US and EU earlier last year. Omalizumab is very well tolerated and has been shown to lead to rapid and sustained improvement in UAS7.
If you or someone you know is dealing with chronic urticaria and are unable to control it with the recommended dosage of antihistamines, you should speak to your doctor to review other options.