Dupixent for hives is novel treatment option for patients with difficult to treatment chronic spontaneous urticaria. Chronic hives is a common condition marked by episodes of elevated, itching, red wheals persisting for more than 6 weeks without a specific known cause. It is estimated that chronic hives affects about 1% of the population.
The mechanism of action of chronic hives is not well understood, however it is rooted in mast cell activation and degranulation. Many treatments exist for chronic spontaneous urticaria, although they may not be effective in all cases.
Xolair is a monoclonal antibody that is effective but not in all cases.
Some studies reported it is not effective in up to 1/3 of cases. Cyclosporine is also effective, but many patients are hesitant to use it because of reported side effects and monitoring.
A recent study published in the Journal of Allergy and Clinical Immunology, titled “Dupilumab as a novel therapy for difficult to treat chronic spontaneous urticaria” looked at to see if Dupixent was a reasonable therapy for Omalizumab (Xolair) treatment failures.
Currently dupilumab is approved for moderate to severe atopic dermatitis and moderate to severe asthma.
And other indications may be coming. Dupilumab for Nasal Polyps
In the study published, 6 patients who failed Xolair for chronic hives were treated with Dupixent of up to 600mg monthly, who responded to it. This may point to a mechanism of involving IL-4 and IL-13. Thy may occur from IL-4 blocking the induction of B cell to plasma cell subclass switching from IgM to IgE as well as limiting the IL-13 inflammatory cascade that leads to itching in eczema and hives.
This report strongly suggests that Dupixent for hives has a potential role in chronic idiopathic urticaria and it warrants further studies.