When to Consider Xolair for Chronic Hives: What You Need to Know
Do you or your child suffer from chronic hives that just won’t go away despite daily antihistamines?
If you’ve been battling with uncontrolled hives despite being on medications, we would like to talk to you about Xolair.
So, What is Xolair?
Xolair (omalizumab) is a humanized monoclonal antibody—a type of biologic treatment that binds to circulating IgE. In simple terms, it reduces the release of inflammatory mediators from mast cells and basophils—the very cells driving your allergic reactions.
In the United States, Xolair is approved as an add-on therapy for:
Patients with moderate to severe persistent allergic asthma: Approved for individuals aged 6 years and older whose asthma is not controlled with inhaled corticosteroids.
Patients aged 12 years and over with chronic spontaneous urticaria (CSU): For those whose hives are not controlled by H1-antihistamines.
Patients aged 1 year and older with IgE-mediated food allergies: To reduce allergic reactions, including anaphylaxis, that may occur with accidental exposure to one or more foods.
Fun fact: Xolair is the first monoclonal antibody approved for chronic idiopathic urticaria—a breakthrough for patients with uncontrolled hives!
Understanding Chronic Spontaneous Urticaria (CSU)
CSU (also known as chronic idiopathic urticaria) is defined by:
Hives or wheals lasting at least 6 weeks
Often accompanied by angioedema (swelling)
Extreme itchiness that can disrupt sleep, school, work, and social life
While some patients see improvements after a few months, about 50% of cases persist for 3–5 years, and in 20% of cases, symptoms can last over 10 years. CSU is caused by histamine affecting your blood vessels, which leads to fluid leakage and those distinctive wheals.
How Does Xolair Work in Urticaria?
Even though CSU isn’t triggered by an allergen in the usual sense, it still follows a similar pathway:
IgE triggers the allergic response.
Xolair attaches to circulating IgE, preventing it from binding to high-affinity receptors (FcεRI) on mast cells and basophils.
The result? Fewer inflammatory mediators released, meaning fewer hives.
The Xolair Treatment Protocol
At the Allergy Immunology Clinic, we typically start treatment with Xolair as follows:
Initial Dose: 300 mg (given as two subcutaneous injections) once every 4 weeks.
If You Respond Well: We’ll lower the dose to 150 mg once a month.
Tapering: If your hives stay controlled, we gradually extend the dosing interval—to 6 weeks, then 8 weeks, and even 12 weeks—before considering stopping the treatment.
This step-wise approach helps us control symptoms while exploring whether—and when—it might be safe to taper off Xolair.
Important Safety Information
While most patients tolerate Xolair very well, there are risks:
Serious allergic reactions (anaphylaxis): Rare but life-threatening.
Injection site reactions: Such as swelling, redness, and pain.
Always receive Xolair under medical supervision and follow your healthcare provider’s instructions.
FAQ – Quick Answers About Xolair for Hives
How is Xolair given?
It’s a subcutaneous injection typically given every 4 weeks. We start with 300 mg (as two injections) and adjust based on your response.When will I know if it’s working?
Most patients start noticing improvements in 8–12 weeks. If there’s no change, we can discuss whether Xolair is the right treatment for you.Can I taper off Xolair eventually?
Yes. If your hives are well controlled, we’ll reduce the dose to 150 mg once a month and gradually extend the interval between doses before considering discontinuation.Is Xolair safe?
Xolair is generally safe when given in a healthcare setting. Your doctor will closely monitor you for any signs of an allergic reaction.How does Xolair differ from antihistamines?
Antihistamines block the effects of histamine. Xolair, on the other hand, reduces the production and effect of IgE—the root of the inflammatory response causing chronic hives.
Experience Effective Urticaria Treatment with Xolair at The Allergy and Immunology Clinic
We specialize in managing chronic spontaneous urticaria (CSU) with personalized Xolair (omalizumab) therapy. Here’s why patients choose us:
✔️ Specialized Care: Our team has extensive experience in treating CSU, ensuring expert evaluation and treatment.
✔️ Tailored Treatment Plans: We develop individualized Xolair therapy plans to effectively address your unique symptoms.
✔️ Comprehensive Support: Beyond treatment, we provide education and resources to help you manage CSU effectively.
✔️ Addressing your Immune System: CSU is closely associated with autoimmune diseases, we are able to help evaluate and address your immunity.
Take control of your chronic hives with our dedicated care. Contact us today to schedule a consultation and learn more about how Xolair can help you.
