by Chronic Idiopathic Urticaria (CIU) Treatment commonly known as chronic hives, is characterized by the appearance of itchy welts on the skin lasting for more than 6 weeks. These hives can come and go and are often accompanied by angioedema – swelling in deep skin or mucosal tissues. While the exact cause is unknown, CIU is considered idiopathic when routine tests and examinations are unable to find a specific underlying cause. It affects up to 1% of the general population globally and is commonly diagnosed in individuals aged 20-40 years. Women are affected more than men.
First line treatments – antihistamines
The first line treatment for mild to moderate CIU involves the use of non-sedating antihistamines in approved doses. Older H1 antihistamines such as hydroxyzine are also prescribed. These drugs work by blocking the effects of histamine – the inflammatory chemical mediator thought to cause urticaria. Common non-sedating options include fexofenadine, loratadine, cetirizine and levocetirizine. These are generally well-tolerated but may not provide full symptom relief for all patients.
Adding leukotriene receptor antagonists
For patients with inadequate response to standard antihistamines, guidelines recommend increasing the antihistamine dose or adding a Leukotriene receptor antagonist (LTRA) such as montelukast. LTRAs block leukotriene production – inflammatory lipid mediators also implicated in urticaria. Studies have shown that the combination of an antihistamine and montelukast is significantly more effective than antihistamines alone for controlling symptoms in many CIU patients. Adverse effects of LTRAs are mild.
Omalizumab as a second line option
When CIU remains uncontrolled despite optimized Chronic Idiopathic Urticaria (CIU) Treatment with antihistamines and LTRAs, the biologic agent omalizumab has become an valuable second-line option. Omalizumab is a recombinant monoclonal anti-IgE antibody that inhibits the inflammatory effects of IgE – an antibody implicated in the pathogenesis of CIU. Multiple randomized controlled trials have found omalizumab to significantly reduce urticaria symptom severity and increase response rates compared to placebo when added to standard therapy. The FDA and EMA have approved subcutaneous omalizumab for the treatment of CIU in patients who remain symptomatic despite H1 antihistamine treatment. Main side effects can include pain or swelling at injection site.
Refractory urticarial
For the small subset of CIU patients who achieve inadequate relief despite optimal treatment with antihistamines, LTRAs and omalizumab, recent guidelines have suggested a trial of cyclosporine A. It is a potent immunosuppressant used off-label that has shown efficacy for urticaria in some uncontrolled case series. Other even less established options that may be tried under specialist guidance include montelukast dose escalation, hydroxychloroquine, dapsone or short term oral corticosteroids. In severe refractory cases, hematologic disorders need to be ruled out and immunomodulators like rituximab discussed on an individual basis. Surgical options are not recommended for CIU.
Psychological impact and quality of life
The unpredictable recurrent nature of wheals and angioedema in CIU makes it a difficult condition to cope with both physically and psychologically. Affected individuals commonly report feeling stressed, anxious, depressed and socially isolated due to the symptoms. Studies show CIU leads to significantly impaired quality of life and work or school absenteeism. Comprehensive care should address any associated psychological impact and ensure optimal treatment adherence. Support groups can help patients cope better through shared experiences.
Latest advances
While its exact pathophysiology remains unclear, research into CIU is gradually improving our understanding. Newer potential pathogenic factors under investigation include autoantibodies, chemokines, neuropeptides, complement activation and inflammasome pathways. This has led to trials evaluating therapies targeting these mechanisms like anti-IL-31 receptor antibodies and janus kinase inhibitors. Investigators are also exploring whether trigger factors such as delayed food allergies, infections, thyroid disorders or autoimmune causes are identifiable in certain subsets. Further elucidating the pathophysiology of CIU will hopefully enable the development of novel targeted therapies to better treat this distressing condition.
Chronic Idiopathic Urticaria (CIU) Treatment poses a significant burden but current Chronic Idiopathic Urticaria (CIU) Treatment approaches have advanced considerably in providing relief for many patients. Antihistamines still form the mainstay of initial treatment, however the availability of additional oral and injectable options has allowed for more personalized symptom control strategies. Improved understanding of the pathogenesis will also accelerate breakthrough therapies. With optimized medical management and addressing psychological impact, the quality of life for CIU patients can continue improving.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile
About Author - Money Singh
Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc. LinkedIn Profile
