Treatment of chronic hives usually includes medicines and lifestyle changes. While there is currently no cure for the condition, many ongoing clinical trials are trying to identify more drug options to treat chronic hives.
Many of these emerging drugs are currently approved to treat autoimmune or allergic conditions. Chronic hives have many similarities to these conditions. This is why researchers think these drugs may also help improve symptoms of chronic hives. Because of this, emerging drugs are currently off-label.
Depending on your specific case, you may be able to participate in emerging research or a clinical trial to treat your chronic hives. Talk with your doctor about your options.
Immunoglobulin E (IgE) blockers
Ligelizumab (QGE031) is a monoclonal antibody drug that blocks the activity immunoglobulin E (IgE). IgE is a protein released by white blood cells. It causes certain immune cells to release histamine. This can lead to symptoms of asthma, chronic hives, and other conditions.1,2
Blocking IgE may help reduce hives and other related symptoms. This is also how omalizumab (Xolair) works. But, phase 3 trials did not prove it more effective than omalizumab. As of late 2022, the makers of ligelizumab are still looking at how this drug can help treat the symptoms of chronic hives.5
Interleukin-4 and interleukin-13 (IL-4/13) blockers
Dupilumab (Dupixent®) is a monoclonal antibody drug that blocks the activity of IL-4/13. These are proteins released by certain immune cells. This can cause other cells to release IgE, which leads to symptoms of allergies and chronic hives.6
The U.S. Food and Drug Administration (FDA) has approved dupilumab to treat asthma and atopic dermatitis (eczema). Some small studies have shown that it improves symptoms of chronic hives. Ongoing phase 2 clinical trials are testing the dupilumab in chronic hives.7,8
Interleukin-5 (IL-5) blockers
IL-5 is a protein released by immune cells. It activates white blood cells (eosinophils) that are involved in allergies and asthma. Eosinophil activation seems to also be involved in chronic hives. IL-5 blockers may reduce symptoms.6
Three monoclonal antibodies that block IL-5 have been used to treat people with chronic hives:6
- Mepolizumab (Nucala®)
- Reslizumab (Cinqair®)
- Benralizumab (Fasenra®)
Ongoing clinical trials are testing these IL-5 blockers in chronic hives.9-11
Antifibrinolytics
Antifibrinolytics are drugs that promote blood clotting. They slow down a process called fibrinolysis, which is the breakdown of blood clots. Inflammatory pathways linked to chronic hives are the same as the pathways of fibrinolysis. This is why researchers think antifibrinolytic drugs may improve symptoms of chronic hives. In general, the risks of these drugs generally outweigh the benefits when treating chronic hives.6
Tranexamic acid (Lysteda®) is an antifibrinolytic used to prevent blood loss and treat hereditary angioedema (swelling beneath the skin). Clinical use of tranexamic acid in chronic hives has not been consistent. However, an ongoing clinical trial is testing the combination of tranexamic acid and an H1 antihistamine for people with chronic hives.6,12
Tumor necrosis factor (TNF) blockers
TNF is a protein released by white blood cells. It is involved in the inflammation process. TNF blockers are often used to treat autoimmune conditions, such as rheumatoid arthritis. People with chronic hives seem to have high levels of TNF. TNF blockers may also improve symptoms of chronic hives.6
Small studies have shown that 3 TNF blockers may treat chronic hives:6
- Adalimumab (Humira®)
- Etanercept (Enbrel®)
- Infliximab (Remicade®)
There are not yet any clinical trials testing these drugs in chronic hives.6
Interleukin-1 (IL-1) blockers
IL-1 is a protein released by immune cells. It is part of the inflammation process. High levels of IL-1 are linked to the development of hives in people with other conditions. This means IL-1 blockers may be helpful for chronic hives.6
Three IL-1 blockers have been shown to be effective in different types of chronic hives:6
- Anakinra (Kineret®)
- Canakinumab (Ilaris®)
- Rilonacept (Arcalyst®)
Ongoing clinical trials are testing IL-1 blockers in chronic hives.13,14
Other drugs
Many other drugs are in early development for chronic hives. They work in different ways to try to reduce symptoms of chronic hives.
Ongoing clinical trials are testing many of these potential drugs in chronic hives. Researchers are also trying to find other new ways to treat chronic hives.15-24