Spontaneous urticaria (hives) is such a common condition but can be difficult to manage. Patients describe itchy welts, swollen and red skin, and sometimes swollen eyes and lips too. The rash typically resolves within 24 hours but then the cycle repeats itself and new rash appears on other areas of the body. It can be incredibly itchy or even painful and can be frustrating to treat.
I myself suffer from urticaria too but mine is set off by temperature changes (“cold-induced urticaria”) and friction (“delayed-pressure urticaria”). Any of my urticaria patients will attest to my empathy with their skin rash; as I have first hand knowledge of how frustrating it can be to manage! When patients present with urticaria, it is important to find out the triggers (heat, sweat, friction, stress, medication etc) and also exclude any other underlying medical conditions that can contribute to their urticaria flaring. This means taking a detailed history for other symptoms and blood tests may be needed. Typically urticaria treatments might involve creams, UV therapy and tablets.
Now a new injectable biologic medication, Omalizumab, is available under the PBS for our patients with chronic spontaneous urticaria since late 2017. Only some dermatologists are able to prescribe this medication (Dr Georgina Lyons and myself satisfy PBS criteria to prescribe this medication). Omalizumab works by binding to circulating IgE; a molecule responsible for setting off an inflammatory cascade, leading to the symptoms of itch and rash. Omalizumab has been on the PBS for a while for the indication of asthma but has been a recent addition to the PBS under dermatology for the indication of Chronic Spontaneous Urticaria (or CSU for short). In the past, patients with CSU have used various combinations of H1 (histamine 1) blockers and H2 blockers, UV therapy, Plaquenil (an anti-malarial tablet that acts to reduce inflammation), mast-cell stabiliser medications and then immunosuppression – all in a bid to control their rash and itching. Now we are finding that patients are able to transition straight from the H1 and H2 blocker combination, to Omalizumab straight away and these patients are reporting great outcomes.
Omalizumab is given as a monthly injection and PBS gives patients 3 months worth of medication at a time. After the 3-month period of medication is up, patients then make an assessment as to whether they need another round of injections or they can take a trial period off the injections and monitor their symptoms to see if there is a flare. If they need another period of treatment, then their dermatologist can apply for another 3 months.
It is a well tolerated medication and some patients with a history of very difficult to control urticaria have had a great response to this medication. We would be happy to offer you an appointment with our team to fully assess and manage your urticaria.