Alternative Therapies - Anti-Inflammatory Medications

Reviewed by: HU Medical Review Board | Last reviewed: November 2022

If your chronic hives symptoms do not improve with antihistamines and other treatments, your doctor may try alternative therapies. One class of these drugs works by reducing inflammation. These are called anti-inflammatories. Anti-inflammatories used for treating chronic hives are known as second-line treatments.1

How do anti-inflammatories work?

Inflammation is your body’s response to harmful things like germs and irritants. It helps the body destroy the germs and remove dead cells. In chronic hives, this inflammation leads to symptoms like redness, pain, and swelling.1

Chronic inflammation may contribute to the development of chronic hives. This is why anti-inflammatory medicines may reduce symptoms of chronic hives.2

However, the U.S. Food and Drug Administration (FDA) has yet not approved any anti-inflammatory drugs for chronic hives. Your doctor must prescribe these drugs "off-label" for chronic hives.2,3

An off-label drug is one that is used to treat a different condition than the one it was approved by the FDA. This also means the FDA has not yet determined the drug is safe when used the way you are taking it.3

Off-label does not mean the drug is unsafe to take. Often, it means there has not been an official clinical trial to test the drug for this specific disease. You should always talk to your doctor about any questions you have about your treatments.3

Doctors will only suggest anti-inflammatory drugs if H1 antihistamines and other treatments do not control your symptoms. There is not yet much evidence that they work for hives. Expert guidelines do not include them in their recommendations. However, they may be helpful because of their low cost.4

Examples of drugs with anti-inflammatory properties

The choice between these drugs depends on many personal factors, such as your other medical conditions. Examples of drugs that have anti-inflammatory properties that may be used to treat chronic hives include:5

  • Dapsone (Aczone®)
  • Sulfasalazine (Azulfidine®, Salazopyrin®)
  • Hydroxychloroquine (Plaquenil®)
  • Colchicine (Colcrys®, Mitigare®)

Drugs with anti-inflammatory properties in clinical trials for chronic hives include:6-8

  • Ligelizumab (QGE031)
  • Dupilumab (Dupixent®)
  • Benralizumab (Fasenra®)

These work in different ways to reduce inflammation. Dapsone and sulfasalazine are the most widely used of these drugs. They may be combined with hydroxychloroquine. Colchicine is rarely used and has shown limited benefit in recent studies.4,5,9

What are the possible side effects of anti-inflammatories?

Side effects can vary depending on the specific drug you are taking and other personal factors.

Side effects of dapsone include:9

  • Bursting of red blood cells (hemolysis).
  • High amount of methemoglobin in the blood, which replaces the normal oxygen-carrying hemoglobin in the blood.
  • Too much methemoglobin can lead to reduced oxygen delivery to the cells.
  • Nerve damage.
  • Low number of white blood cells called granulocytes.
  • Allergic reactions.

Sulfasalazine usually has a lower risk of severe side effects. Side effects of sulfasalazine include:4

  • Nausea
  • Headache
  • Low number of white blood cells
  • High levels of certain liver enzymes

Your doctor will perform blood and urine tests to make sure these drugs are safe for you. They will also monitor liver function during treatment. People with anemia should not take dapsone. Your doctor may suggest sulfasalazine instead.4

These are not all the possible side effects of anti-inflammatories. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking anti-inflammatories.

Things to know about anti-inflammatories

Anti-inflammatory drugs may improve symptoms of chronic hives. These are approved to treat other chronic inflammatory conditions, not chronic hives. We need more research to know how effective these drugs are in treating chronic hives.

Take anti-inflammatory drugs as your doctor prescribes. Your doctor may prescribe a dose and change it over time as your symptoms change.4

Some of these drugs may harm an unborn baby and are unsafe to take while pregnant or breastfeeding. Talk to your doctor about your options for birth control and breastfeeding while taking immunosuppressants.4

Off-label drugs may or may not be an option for you. Knowing what these are, as well as their side effects, can help you when talking to your doctor about these drugs.

Before beginning treatment for chronic hives, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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