Ep. 174: Choosing Between Chronic Hives Treatment Options

Doctor InterviewFood AllergiesAllergiesAsthmaEczemaImmunologyPatient InterviewEOEAAII PodcastMast Cell DiseaseCSUUrticariaBiologicsHealth InsuranceType 2 Inflammation

Sep 11

Written By Kortney Kwong Hing

Part of the series: Allergy, Asthma & Immunology Innovations Podcast

This podcast was made in partnership with Allergy & Asthma Network.

We thank Genentech and Novartis for sponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

How do you decide what is the right medication for you after antihistamines are not working to manage your chronic hives?

Dr. David Lang, one of the authors of the new chronic urticaria guidelines, walks through every advanced treatment option the way he would if he had as much time as possible with a patient in his office. Along with Dr. Gupta, they cover the three treatments available when antihistamines are not enough, what each one asks of you week to week, and how to walk into your appointment ready to choose.

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What we cover in our episode about chronic hives treatment

What to think about when choosing a medication: benefit, harm, and burden. Dr. Lang explains why these are three different things, and why the one most patients are never asked about is what a treatment costs them in time, appointments, and schedule.
The three advanced options side by side. Omalizumab (Xolair), dupilumab (Dupixent), and remibrutinib (Rhapsido) compared on how often you take them, how fast they work, and what the side effects really are.
What the scary side effects actually mean. Dr. Lang walks through the anaphylaxis, cancer, and heart risks tied to omalizumab, and explains how likely each one really is.
When blood tests for chronic hives come back into the picture. Testing will not tell you why you have hives, but it may hint at which of the three treatments is more likely to work for you.
Insurance may choose your starting point. All three treatments are approved for chronic hives, so if your plan covers one over another, that is a reasonable place to start, not a compromise.

About our guest

Dr. David M. Lang is Professor Emeritus in the Department of Allergy and Immunology at the Cleveland Clinic. He was part of the work group that wrote the 2026 chronic urticaria practice parameter, and also worked on the previous version published in 2014.

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