A massive global study has ranked the best and safest treatments for chronic hives when antihistamines fall short. The findings provide a clear treatment roadmap for both patients and clinicians alike. Redness, swelling and intensely itchy wheals – those are the hallmark symptoms of urticaria, commonly known as hives. If symptoms persist for six weeks or more, the condition is considered chronic. When antihistamines, the standard first-line treatment, fail to provide relief, systemic therapies that work throughout the body are the next step. A new large, international study, led by McMaster University in Canada, has comprehensively compared the safety and effectiveness of drugs and immunotherapies for chronic urticaria. The findings eliminate the guesswork in finding an appropriate – and, importantly, effective – treatment. “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 corresponding author Derek Chu, MD, PhD, an assistant professor in McMaster’s Department of Medicine. The researchers analyzed data from 93 studies and 11,398 participants, primarily adolescents and adults with moderate to severe symptoms of chronic urticaria. Only randomized controlled trials for systemic treatments were included; trials for antihistamines, steroids, and alternative medicines were excluded.