Alternative Treatments for Chronic Urticaria: Beyond Antihistamines and Steroids

Other treatment medications or methods for urticaria?

Allergic reactions to medications (such as pain relievers) causing urticaria that remain unresolved can be quite challenging.
Despite ongoing medical consultations and continuous medication, the condition has persisted for over three months.
Besides antihistamines and corticosteroids, are there any other medications or methods covered by health insurance that could provide a cure? The individual has a history of allergies but has never experienced urticaria before.
After the onset of urticaria, the IgE level was found to be 795.
Blood tests indicated allergic foods, which have not been consumed since the urticaria appeared, yet the condition continues to recur.
Foods like shrimp and shellfish were previously consumed without any allergic reactions.
Are the results from the allergy blood tests reliable? Is it common for urticaria due to drug allergies to recur? Could this be related to a malfunction in the immune system?

dinner, 50~59 year old female. Ask Date: 2015/09/04

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
The duration of an allergic reaction to painkillers can vary, but lasting more than three months is indeed quite long.
It would be advisable to discuss the possibility of further immunological testing with your physician to rule out any immune function issues.
Chronic urticaria, which lasts for three months or longer, may not necessarily be caused by food or drug allergies (unless there is ongoing medication use or exposure to allergenic foods).
It could also indicate a mild immune dysfunction, so discussing this possibility with your doctor is recommended.

Regarding the accuracy of blood tests for allergens, it depends on the testing reagents provided by different manufacturers.
However, regardless of the manufacturer, if the values are high, the accuracy is generally more reliable; conversely, if the values are low, they should be correlated with clinical symptoms for a more accurate diagnosis.
We do not solely rely on blood test results; clinical symptoms are also taken into account.

Please also pay attention to the circumstances that may trigger your urticaria and keep a record of them, whether they are related to exercise, weather, seasons, or food.
Providing this information to your physician can assist in diagnosis.
If it is chronic urticaria, the treatment duration may be longer, primarily using antihistamines, and corticosteroids may be used "short-term" if necessary.
Other immunosuppressive medications are only considered in extreme cases.
Therefore, it is advisable to discuss your treatment plan with your physician to alleviate your anxiety.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2015/09/04

More Info

Chronic urticaria, or hives, can be a frustrating condition, especially when it is triggered by medication allergies. It is understandable that you are seeking alternative treatments beyond antihistamines and steroids, particularly since you have been experiencing persistent symptoms for over three months despite ongoing treatment.
First, it is important to recognize that chronic urticaria can be multifactorial, meaning that various triggers can contribute to its development. In your case, it appears that medication allergies have played a significant role. The elevated IgE levels you mentioned indicate an allergic response, which can be associated with various allergens, including food, medications, and environmental factors. It is not uncommon for individuals with a history of allergies to develop urticaria, even if they have not experienced it in the past.

In terms of treatment options, while antihistamines and corticosteroids are the mainstays of therapy, there are additional approaches that may be beneficial:
1. Leukotriene Receptor Antagonists: Medications such as montelukast (Singulair) can help reduce inflammation and may be effective in some cases of chronic urticaria. They work by blocking leukotrienes, which are inflammatory mediators involved in allergic responses.

2. Omalizumab (Xolair): This is a monoclonal antibody that targets IgE and is approved for chronic spontaneous urticaria that is resistant to antihistamines. It has shown significant efficacy in reducing hives and itchiness in patients with chronic urticaria. Omalizumab is typically administered as an injection every few weeks and may be covered by health insurance, depending on your plan.

3. Dapsone: This antibiotic has anti-inflammatory properties and has been used off-label for chronic urticaria. It may be considered in cases where other treatments have failed.

4. Immunosuppressants: In severe cases, medications such as cyclosporine may be used to suppress the immune response. However, these drugs come with potential side effects and require careful monitoring.

5. Lifestyle Modifications: Identifying and avoiding known triggers is crucial. Keeping a diary of your symptoms, food intake, and medication use can help pinpoint potential allergens. Additionally, stress management techniques such as mindfulness, yoga, or cognitive behavioral therapy may help reduce the frequency and severity of flare-ups.

6. Dietary Considerations: Although you mentioned that you have avoided certain foods after identifying them as allergens, it may be worth consulting with an allergist or a dietitian to explore potential hidden allergens or cross-reactivity with other foods.

Regarding the reliability of allergy testing, it is important to note that while blood tests for specific IgE can provide valuable information, they are not always definitive. False positives can occur, and clinical correlation with your history and symptoms is essential. An allergist may recommend skin prick testing or other diagnostic methods to further evaluate your allergies.

As for the question of whether recurrent urticaria is a sign of an immune system disorder, it is possible that your immune system is reacting inappropriately to certain stimuli. Chronic urticaria can sometimes be associated with autoimmune conditions, where the body mistakenly attacks its own tissues. A thorough evaluation by a healthcare provider, including possible autoimmune screening, may be warranted.

In conclusion, while antihistamines and steroids are commonly used for chronic urticaria, there are several alternative treatments available that may be effective, especially in cases resistant to standard therapy. It is crucial to work closely with a healthcare provider, preferably an allergist or dermatologist, to develop a comprehensive management plan tailored to your specific situation. They can help guide you through the process of identifying triggers, exploring alternative treatments, and monitoring your condition over time.

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