New treatments for chronic hives are currently being studied. Chronic urticaria or hives is defined as having urticaria for more than 6 weeks duration. Chronic hives have been called chronic idiopathic urticaria, chronic autoimmune urticaria or chronic spontaneous urticaria. There is also chronic inducible urticaria which can be brought on by cold, delayed pressure, solar, heat, vibratory, cholinergic, contact and aquagenic.
The prevalence is approximately 1% and it can last between 2-5 years. About 35-50% can experience spontaneous remission in 1 year. Nearly 40% of patients also experience angioedema.
In a previous post we discussed the treatment for chronic spontaneous urticaria.
Here we will discuss emerging and new treatments for chronic hives.
- Ligelizumab (QGE031)- This is a humanized IgG1 monoclonal antibody that binds to the C epsilon 3 domain of IgE with a higher affinity than Xolair. QGE031 may represent a future treatment for those patients with omalizumab-refractory CSU before the use of immunosuppressants.
- CRTH2 Antagonist (AZD1981)-There has recently been increasing interest in the use of CRTH2 antagonists as novel therapeutics for the management of eosinophilic esophagitis, asthma and allergic rhinitis. AZD1981 is an oral, selective, reversible CRTH2 antagonist that recently underwent a phase 2 trial.
- Fenebrutinib (GDC-0853)-This is a highly selective, reversible oral Bruton tyrosine kinase (Btk) inhibitor currently undergoing phase 2 clinical trials.
- Anti-Siglec-8 (AK002)-This is currently being explored in clinical trials for the treatment of chronic spontaneous urticaria, eosinophilic gastritis, mastocytois, and severe allergic conjunctivitis.
- Topical Syk Inhibitor (GSK2646264)- Spleen tyrosine kinase (Syk) is a member of the nonreceptor cytosolic tyrosine kinases.
The current available treatments recommend the use of H1 antihistamines (up to 4 times the upper limit of normal dosing) with the possible use of Singulair, H-2 antihistamines or alternative antihistamines before initiation of Xolair; use of immune suppressants is reserved for recalcitrant disease.
New targets are listed above and studies are underway to allow a more personalized approach to therapy.