I have recurrent hives. How long should I stay on treatment?

Question

Hello doctor,

I am a 27-year-old male, experiencing recurrent hives for the past six weeks, mainly on my arms and back. Sometimes they itch badly at night. Tried Cetirizine 10 mg daily with minimal relief. Blood tests show normal eosinophils, and IgE is 110 IU/mL. So I have a few concerns -

Could this be chronic spontaneous urticaria or related to something I am eating?
Should I consider higher doses of antihistamines or add Omalizumab?
Are there triggers I might not realize, like stress or environmental allergens?
How long should I continue treatment if symptoms persist?
Is there a risk this will turn into a more serious allergic condition over time?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I hope you are doing fine. Based on your history, it appears that you have chronic urticaria. It can be spontaneous or related to some triggers. Triggers are of different types, such as heat, sweat, stress, sun exposure, and even scratching yourself.

Your previous investigations show that it is not related to an allergic cause. Generally, the first-line treatment is a non-sedating antihistamine such as Cetirizine.

The next management step in your case will be to increase the dose of Cetirizine from 10 mg (milligrams) to 20 mg. We can go up to 40 mg per day if needed. Let us start by taking a 10 mg tablet twice daily for one week, and will up-titrate if necessary. If a high dose of antihistamine fails, consider adding Omalizumab.

To answer your question regarding the duration of treatment, I am afraid you have to take medicine as long as you experience symptoms. However, most cases resolve within a couple of years.

No evidence that having urticaria increases your risk of developing a serious allergic reaction over time.

I hope I answered your query satisfactorily. Let me know if you have any other questions.

Thank you and take care.

Regards.