Scratched
Many people think of hives as a minor irritant.
But for patients, especially those with a chronic version of the disease, it induces anxiety because it can appear out of the blue, says Gil Yosipovitch, professor of dermatology at the University of Miami Miller School of Medicine. The subsequent stress can compound the condition. And scratching at hives can affect sufferers’ sleep. “The quality of life of these patients is bad,” Yosipovitch says.
Chronic spontaneous hives has no clear trigger. It looks like raised bumps or welts on the skin that stay for six weeks or more. Almost 1% of people globally live with the condition.
That’s likely an undercount, says Lynda Mitchell, chief executive officer of the Allergy and Asthma Network. Patients spend, on average, two to four years between symptom onset and diagnosis. They might mistake their hives for an allergic reaction. Stigma and lack of awareness often leads them to mask the disease. “People think you have something contagious,” Mitchell says.
Gender bias in healthcare may make patients less likely to have their condition treated seriously. Women are twice as likely as men to develop CSU, or chronic spontaneous urticaria, the medical term for chronic hives. And women are more likely to have their concerns dismissed.
Patients with CSU, thinking they have an allergic reaction, may turn to an allergist and receive steroids that only tame the rash while the flare-ups continue. The complexity of CSU often means an allergist and dermatologist have to team up to tackle a patient’s case. But there’s a national shortage of allergists. And “many patients don’t even see a dermatologist,” says Yosipovitch.
Effective treatment options are also limited. Antihistamines are the first line of defense but 30% of patients don’t respond to them, Yosipovitch says. Injections like Xolair and Dupixent can intimidate patients. But a new oral treatment approved by the US Food and Drug Administration may change the picture.
Rhapsido is a twice-a-day pill developed by Novartis. While the origins of CSU are unknown, some doctors point to the body’s mast cells in the immune system. Overactivity in those cells can provoke inflammation, triggering the release of a protein called Bruton tyrosine kinase that Rhapsido works to block.
An injection that persists in the bloodstream usually requires a visit to the doctor every few weeks. A daily pill allows patients to have more control over their dosages and can be stopped on a dime.
Rhapsido has shown promise, Yosipovitch says. Some of his patients experienced relief within a few days of their first dose. “It’s the drug of this year,” he says. — Rainier Harris
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