Hives are never fun. Intolerable itching, grotesque swelling, nasty red splotches and welts covering the body, hives can clearly make for a very bad day. The only thing worse than a brief (acute) attack of hives is an unrelenting, daily outbreak lasting for months and even years. Such is the case with patients with chronic hives.
Chronic hives not only linger for what must seem like an eternity, but in 95% of cases, no cause for the misery is found. When a condition or disease occurs without a known cause, it is referred to as idiopathic. The term we use for hives that last longer than several months and do not have an identifiable cause is called chronic idiopathic urticaria or CIU.
For some patients, a daily antihistamine is all that is needed to control outbreaks. They are the lucky ones. For others, large doses of antihistamines, up to four a day, as well as high doses of steroids are required. When this fails, other medications, some used in the treatment of organ transplant rejection, most with serious side effects, are needed just to stay clear.
Any news of new treatment options for CIU are welcome. This news may be coming in the form of a new indication for a not-so-new asthma drug. In Europe, Novartis’ asthma drug Xolair (omalizumab) was approved for the treatment of (CIU). It is expected that approval in the US will follow soon.
The good news is that it will provide a much needed alternative for patients whose symptoms cannot be controlled with antihistamines alone, and need daily steroids.
The bad news is that Xolair is a genetically engineered wonder drug. Specifically it is a glycosylated IgG monoclonal antibody produced by cells of an adapted Chinese hamster ovary cell line and secreted in a cell culture process employing large-scale bioreactors. All of this means it is very, very expensive; about a thousand dollars per injection (it is given by injection by the way) and two shots a month are often needed. Since CIU is a chronic condition without a cure, the injections may be needed for many, many years.
This “good news” is coming at a time when high deductible insurance plans are becoming the norm so most of the cost of medications, including the thousand-dollars-an-injection variety, will be out of pocket for the patient. I am not sure how much more “good news” some patients will be able to stand.