Ep. 177: Treating Chronic Hives in Special Populations (Women, Pregnancy, Kids, Older Adults & Multiple Conditions)
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 supporting 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.
Chronic hives guidelines give doctors a roadmap for treatment, but not everyone fits the same path. Pregnancy, breastfeeding, menopause, childhood, getting older, and living with more than one chronic condition can all change how chronic spontaneous urticaria (CSU) is treated.
Kortney and Dr. Payel Gupta are joined by Dr. Allison Ramsey, an allergist and immunologist, to walk through the special populations section of the chronic urticaria guidelines.
What we cover in our episode about chronic hives in special populations
Why it's not your fault. Dr. Ramsey explains how she "absolves" patients of hunting for a trigger, because CSU starts with the immune system, not with anything outside the body.
Why women are more burdened by chronic hives. About 70% of people with CSU are women. Estrogen can push the immune system toward autoimmunity, and hives can shift with the menstrual cycle and become less common after menopause.
Pregnancy and breastfeeding. Non-drowsy antihistamines are considered safe, and pregnancy data from asthma suggest omalizumab (Xolair) and dupilumab (Dupixent) are too.
Adults 65 and older. Higher antihistamine doses can cause sleepiness and raise the risk of falls, so share every medication you take. Biologics don't interact with other medicines.
Living with more than one condition. People with CSU are more likely to have other autoimmune conditions. If you also have asthma, eczema, nasal polyps, or food allergy, one medication may treat more than one condition, so tell your doctor about everything.
Chronic hives in children. Most hives in kids come from viruses and go away quickly. When kids do have CSU, they often respond better to antihistamines than adults.
About our guest
Dr. Allison Ramsey is an allergy and immunology physician at Rochester Regional Health and Clinical Associate Professor of Medicine at the University of Rochester in New York. She treats children and adults across the full range of allergic and immunologic conditions, including chronic spontaneous urticaria. She is involved in investigator-initiated research and pharmaceutical trials at her center, and drug allergy is one of her main areas of interest.
More resources about chronic hives
Chronic Urticaria: Treatment and Management
What if I Can’t Afford My Medication for Chronic Hives?
What Is Chronic Urticaria
More about omalizumab (Xolair)
More about dupilumab (Dupixent)
More about remibrutinib (Rhapsido)
More CSU episodes
Timestamps
Our episode about treating chronic hives in special populations
02:21 How an allergist explains CSU to patients
05:51 What "special populations" means in the guidelines
06:30 Why women are more burdened by chronic hives
08:37 What to consider when treating women with CSU
09:51 Planning a pregnancy with chronic hives
15:11 Breastfeeding and hive medications
15:58 Chronic hives after menopause
16:57 Chronic hives in adults 65 and older
19:45 Managing chronic hives with other conditions
23:15 How chronic hives show up in children
26:17 Why guidelines include special populations
