If you have chronic spontaneous urticaria (CSU), also called chronic urticaria, and treatments like antihistamines and steroids aren’t helping, you may be a good candidate for biologics.
What are organic products?
Biologics are drugs that target specific antibodies, molecules, and cellular receptors that cause inflammation and can trigger an allergic reaction like CSU.
Omalizumab (Xolair) is the only FDA-approved biologic for CSU. It is approved for adolescents and adults 12 years and older who suffer from chronic hives. This is an injection that you receive about once a month. It blocks IgE, the antibody that causes allergies.
When you try a biologic drug for the first time, your doctor gives you the shot to make sure everything is going well. “There is about a 1 in 2,000 chance of having an allergic reaction to the drug, so the first few doses are given in a doctor’s office or [an] infusion clinic,” says Kara Wada, MD, an allergist and immunologist at Wexner Medical Center at Ohio State University in Columbus.
Your doctor may recommend that you continue to take your other CSU medications at the same time.
Do organic products work well?
Research suggests that biologics are an effective treatment for CSU with a low risk of side effects.
In one study, over 70% of participants felt better within 24 weeks of taking a biologic drug. If a biologic helps relieve your CSU symptoms, you may also see improvements in your sleep quality, stress levels, and quality of life.
Organic products are considered weak–risk of side effects, compared to immunosuppressive and anti-inflammatory drugs for CSU.
When to try an organic product
Your doctor may recommend a biologic if traditional treatments for CSU aren’t working for you.
“Generally, I start considering a biologic if a patient has day-to-day symptoms that don’t respond well to antihistamine medications,” says Wada.
With CSU, it’s best to take a step-by-step approach. The first step may be over-the-counter antihistamines. Your doctor may recommend higher doses of antihistamines than you would take for other allergies.
Your doctor may also recommend steroids or other immunosuppressive drugs for a short time.
“It may take a few weeks to improve,” says Viktoryia Kazlouskaya, MD, PhD, dermatologist and dermatopathologist at Khrom Dermatology & Aesthetics in Brooklyn, NY. “Patience is the key.”
If your body is resistant to high doses of antihistamines, your doctor may recommend a biologic medication.
What organic products are available now
Although omalizumab is the only approved biologic for the treatment of CSU at present, there are more on the horizon. “Other biologics are under investigation, but not yet FDA approved,” Kazlouskaya says.
Some doctors may use approved biologics to treat other conditions. This is called off-label use. They can try biologics like benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), reslizumab (Cinqair), and secukinumab (Cosentyx) to treat CSU.
Researchers are studying the following biologics to see how well they treat UHC:
- Benralizumab (Fasenra), mepolizumab (Nucala) and reslizumab (Cinqair). These drugs are approved to treat asthma, but not CSU.
- Dupilumab (Dupixent). In a small study, this drug helped people who did not respond to omalizumab.
- Ligelizumab (QGE031). Like omalizumab, it is an antibody that binds to IgE.
- Secukinumab (Cosentyx). This medication may help people with chronic hives who are not getting relief from other treatment options.
Doctors hope to have more options as studies continue. With more biologics to choose from, doctors can use predictive biomarkers to choose which one is most likely to work for you.
What to consider with organic products
Although they have many benefits, organic products have also been shown to several drawbacks.
Inconvenience. You may need to go to a doctor’s office every month to get your shot or IV. “If you’re low-risk, you might be able to do it at home,” Wada says, “but it’s less common.”
High costs. “Organic products also come at a high price,” says Wada. “Most people will need insurance coverage or have to rely on drug company co-payment assistance programs to help offset costs.” In addition to the cost of the biologic, you may also need to pay your doctor’s office or IV center for administrative costs if they charge for it.
Long term effect. Although studies suggest that biologics improve the symptoms of CSU, it is unclear whether they can alter the long-term course of your CSU. If you are taking a biologic drug and lower your dose or stop taking it altogether, your symptoms may return. You may need to take a biologic for a long time to trigger remission.
Health Insurance Considerations
“Unfortunately, it’s very difficult to get biologics for CSU patients, especially if they don’t have private insurance coverage,” says Kazlouskaya.
You may have to wait a few months for approval. Your health insurance company may tell you to try a cheaper drug first, even if it isn’t effective for UHC.
Even if your health insurance approves a biologic product, you may still incur high out-of-pocket costs, depending on the type of plan you have. “Some high-deductible health plans require patients to pay their fees before coverage kicks in,” Wada says.
If you have Medicare, you are not eligible for co-payment assistance programs.
Biologics can work well and relieve you of the symptoms of CSU. But they are not for everyone. Talk to your allergist about what’s right for you and if it’s time to try a biologic.