Treatment Journey: Part 1
Getting a diagnosis of chronic hives can be hard. Finding a treatment regime that works can be even harder. There are many different treatment options available for chronic hives, including antihistamines, biologic agents, immunosuppressants, mast cell stabilizers, and more. I’ve tried a few things along my journey to understand and treat my chronic hives and want to share my experience with you. Please be aware that these are treatments I discussed with my personal doctor, and together we weighed the pros and cons of each medicine. What works and is safe for me may not work for you, and vice versa. Always talk to your doctor before trying something new.
One of the first things my doctor recommended was switching to a different antihistamine. I had been taking Claritin for many years, but my doctor suggested switching to Zyrtec, as it can be more effective at managing the symptoms of autoimmune hives. While the switch helped some, there was definitely room for improvement. My doctor quickly escalated my dose to two tablets twice a day, instead of one tablet twice a day, which is the instructions for over the counter Zyrtec. Going up to four tablets a day definitely improved things, but after a few months, it just wasn’t cutting it.
With having such a severe case of chronic hives, there was no way that antihistamines alone would control my symptoms. So my doctor prescribed a medicine called Mycophenolate, or CellCept. Cellcept is a medication that is used to suppress the immune system. It is frequently used as an anti-rejection drug, usually used for kidney transplants. Since my type of hives are predominately caused by my immune system attacking itself, taking medicine to inhibit the immune system makes sense. But, the downside of preventing your body from attacking itself means that your body is also less capable of attacking other kinds of infections.
For me, the ramifications of being immunosuppressed were, and are, significant. I deal with a multitude of chronic health conditions, some of which lower my ability to fight infection anyway, so adding Cellcept significantly increased my risk of becoming very ill from a virus or bacteria. In turn, I have pretty strict rules about where and when I can go out and must take extra precautions while I’m out and when I get back home. I continue to wear a mask everywhere I go, I’m careful to use hand sanitizer frequently, and do most of my shopping remotely. Being on immunosuppressants basically means that I’m in perpetual quarantine and I only go out when I absolutely have to.
Cellcept has proven to be the most effective at controlling my symptoms, particularly my facial swelling. While I still get quite itchy sometimes, I don’t have many hives. My face still gets puffy if I get overheated, but my eyes don’t swell shut like they used to.
I’m honestly not sure at which point this medication was added to my regime. I get the itchiest at night when I’m trying to fall asleep, which is more than frustrating. My doctor put me on a very low dose of Doxepin, which is in a class of medicines called tricyclic anti-depressants. It can be used to treat anxiety and depression, is used as a sleep aid, and has properties that also inhibit the release of histamine. I have not noticed that it makes me particularly tired after taking it, but it really does help with the itching I get at night.
There is so much more to come as far as my treatment journey goes. Antihistamines and immunosuppressants are only a few types of medications that I’ve used to help control my hives. In my next installment, I will discuss my experience with two biologic medications, Xolair and Dupixent.
How well do you feel you manage your chronic hives?