Treatment of urticaria
Treatment with medication is carried out in a similar way in connection with all cases of chronic urticaria.
In accordance with a three-stage scheme, the following medicines are used.
- Leukotriene antagonists
- Cyclosporin A
- Omalizumab (new in therapy)
These drugs, which counteract the effects of histamine and are well-known to allergy sufferers, are used first. Initially, a simple daily dose is recommended, such as is commonly used in connection with allergy patients. This corresponds, for example, to 5 mg of levocetirizine or desloratadine or 10 mg cetirizine or loratadine or 20 mg of bilastine or 180 mg of fexofenadine. If, after two weeks of continuous administration of the antihistamine, there is still discomfort, a prescription for a much higher dose can be issued by a doctor. Up to four times what is specified in the package leaflet as the usual dose. This is not dangerous. However, high doses cause fatigue or sleepiness in some people.
About two-thirds of all urticaria patients can live well with the disease with antihistamines and other non-pharmacological measures. However, further options are available for the remaining third.
Leukotrienes are chemical messengers that are created in connection with inflammation and play a role in the development of asthma symptoms such as swelling and narrowing of the airways. This drug, too, is therefore used primarily for asthmatics, but also is also effective in treating some urticaria patients.
Leukotriene antagonists such as Montelukast enhance the effects of pro-inflammatory leukotrienes. However, they are considered to be less effective than antihistamines.
Cyclosporin A suppresses the immune system and thus also the mast cells. It is also used for severe psoriasis, severe atopic dermatitis or in chronic arthritis / rheumatoid arthritis. It can cause—sometimes severe—side effects and therefore therapy must be closely monitored.
A new drug is omalizumab. This drug, too, was originally developed to treat asthma. Its effectiveness against urticaria was discovered by chance. Omalizumab is not taken as a tablet but injected under the skin. Omalizumab is effective against immunoglobulin E (IgE). Actually, this immunoglobulin—at least this has been believed so far—plays only a minor role in most forms of urticaria. However, it is known that in the case of allergic patients IgE plays a very important role in the activation of mast cells. Presumably, the blocking of IgE by omalizumab simply hinders the activity of mast cells or the "cascade", which leads to ever more hives and angioedema.
There are numerous clinical studies that show that omalizumab is good and safe but above all that it usually works very quickly. If discomfort cannot be controlled with this regimen during a short period, cortisone can be administered as a tablet or an injection. This solution should always be used as a single therapy or as short-term therapy. Permanent treatment with cortisone is not suitable in connection with urticaria.
Experimental methods include, for example, symptomatic treatment with probiotics, the so-called histamine habituation therapy (with histaglobin), autologous whole blood injections, and acupuncture.
In cases of severe chronic urticaria, e.g. in cases in which there is mucosal swelling that causes difficulty swallowing and shortness of breath, constant carrying of a so-called emergency kit with which severe urticaria attacks can be controlled is recommended. Most such emergency kits contain a fast-acting cortisone preparation and an antihistamine.