Biologics for Chronic Hives

Biologics are an option for people with chronic hives. Doctors usually suggest them when H1 antihistamines do not work well enough to control symptoms.

How do biologics work?

Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. The process of making biologics turns these cells into drugs that can prevent, treat, and cure disease.^1,2

There are many types of biologics, such as vaccines and blood transfusions. The most important biologics in chronic hives are monoclonal antibodies. These are proteins designed to attach to a certain target protein in your cells.^1,2

Examples

The US Food and Drug Administration (FDA) has approved 2 biologics for people with chronic hives who do not get relief from H1 antihistamines. These are:^3,4

• Omalizumab (Xolair®) – Approved for adults and children 12 years and older. Xolair attaches to a substance in your blood called immunoglobulin E (IgE). IgE is an antibody that triggers allergic reactions. By blocking IgE, the drug stops your immune cells from releasing histamine and other chemicals that cause hives.
• Dupilumab (Dupixent®) – Approved for adults and children 12 years and older. Dupixent blocks 2 specific proteins called interleukin-4 (IL-4) and interleukin-13 (IL-13). These proteins drive the type of inflammation that leads to chronic hives. Blocking them helps reduce the itch and the number of hives.

What are the possible side effects?

Side effects can vary depending on the specific treatment you are taking.^3,4

Possible side effects of Xolair include:³

• Nausea
• Upper respiratory tract infections
• Joint pain
• Headache
• Cough

Xolair has a boxed warning, the strictest warning from the FDA. It has this warning because it may cause severe allergic reactions (anaphylaxis). A reaction can occur after any dose and can be life-threatening. Go to an emergency room right away if you notice any signs of anaphylaxis, such as:³

• Wheezing, shortness of breath, or chest tightness
• Low blood pressure, dizziness, or fainting
• Flushing or feeling warm
• Swelling of the throat or tongue

Your doctor will give you information about treating anaphylaxis. They should also give you an epinephrine auto-injector to use.³

Possible side effects of Dupixent include:⁴

• Reactions at the injection site (pain, redness, or swelling)
• Eye problems, such as pink eye (conjunctivitis) or dry eyes
• Cold sores in your mouth or on your lips
• Throat pain

These are not all the possible side effects of biologics. Talk to your doctor about what to expect when taking these drugs. You should also call your doctor if you have any changes that concern you when taking a biologic.^3,4

Other things to know

Both Xolair and Dupixent are given as injections under the skin (subcutaneous). You usually start these treatments in a doctor’s office. After some training, your doctor may allow you or a caregiver to give the injections at home.^3,4

Before taking these drugs, tell your doctor if you:^3,4

• Have any allergies, especially to latex
• Have sudden breathing problems
• Have ever had a severe allergic reaction (anaphylaxis)
• Have ever had a parasitic infection or cancer
• Are pregnant or planning to become pregnant

Biologic drugs can be expensive. Many people with chronic hives find relief with cheaper drugs, such as antihistamines. However, if those do not work, your medical insurance may help cover the cost of a biologic. Work with your doctor to find the best option for you.⁵

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.