A groundbreaking international study led by McMaster University researchers has identified the most effective and safest treatments for chronic urticaria, commonly known as chronic hives, through the first comprehensive network meta-analysis comparing more than 40 treatment options for this debilitating condition.
Published in The Journal of Allergy and Clinical Immunology on July 15, 2025, the study analyzed 93 randomized controlled trials involving over 11,000 participants to provide evidence-based guidance for managing chronic hives, which affects approximately one percent of the population and can severely impact quality of life, sleep, and productivity.
Top-Performing Treatments Identified
The research identified several standout treatments based on effectiveness and safety profiles. Omalizumab, an injectable antibody drug, and remibrutinib, a new oral medication currently under FDA review, emerged as among the most effective treatments for reducing hives, itch, and swelling.
Omalizumab works by blocking the action of Immunoglobulin E, an antibody that promotes allergic reactions. The drug is sold under the brand name Xolair, and earlier this year the FDA approved a biosimilar form called Omlyclo developed by Celltrion.
Remibrutinib, developed by Novartis, represents a promising oral treatment option. Clinical trials have demonstrated that this pill helps more than half of patients with chronic hives by blocking an enzyme cascade that prompts histamine release.
Additional Effective Options
Dupilumab, another injectable antibody drug marketed as Dupixent, also showed significant promise, particularly for reducing hives. Approved in 2017, this medication works by blocking two inflammatory proteins, interleukin-4 and interleukin-13.
The analysis also evaluated cyclosporine, a more affordable and time-tested treatment option. While the drug demonstrated effectiveness against hives, researchers noted it carries a higher risk of side effects, including kidney toxicity and high blood pressure. The study found cyclosporine "may be among the most harmful in increasing the frequency of any adverse events."
Clinical Impact and Future Guidelines
"This first comprehensive analysis of all advanced treatment options for chronic urticaria provides a clear and evidence-based 'menu of treatment options' for patients and their clinicians to choose from," said Derek Chu, senior author and assistant professor in McMaster's Department of Medicine.
Prior to this study, patients and clinicians had to navigate a growing list of treatment options without comprehensive, up-to-date evidence comparing their relative effectiveness and safety profiles.
The research findings will be instrumental in developing new international clinical guidelines for treating chronic hives, providing healthcare providers with evidence-based recommendations for managing this challenging condition.
Understanding Chronic Hives
Chronic hives occur when skin cells release histamine as part of an allergic reaction. This biochemical process causes tiny blood vessels to leak, with the leaking fluid forming into the characteristic swollen welts that can cause intense itching and discomfort for patients.
The comprehensive nature of this meta-analysis, examining data from nearly 100 clinical trials, represents the most thorough evaluation of chronic urticaria treatments to date, offering patients and healthcare providers unprecedented clarity in treatment decision-making.
