Effect of omalizumab on patients with chronic urticaria

Chronic urticaria (CU) is often difficult to treat. Approximately 40% to 50% of patients with no apparent cause are believed to have an associated autoimmune profile that may play a pathogenetic role.

To describe 3 patients with CU refractory to conventional treatment who responded to omalizumab therapy.

Treatment was maximized with antihistamines, antileukotrienes, and histamine2 blockers with no improvement. Systemic steroids provided only temporary relief. Laboratory workup revealed 1 patient with a low IgE level and elevated anti-IgE receptor antibody level, 1 patient with an elevated IgE level but a normal anti-IgE receptor antibody level, and 1 patient with a very elevated IgE level and an elevated anti-IgE receptor antibody level. All 3 patients were prescribed omalizumab therapy every 2 weeks.

Two patients had total clearing of urticaria within 1 week and 1 patient within 6 weeks of starting omalizumab therapy. The patient with the elevated anti-IgE receptor antibody level had normalization of the level after starting treatment.

Omalizumab may have a beneficial effect in the treatment of CU. Further studies are needed to confirm this effect and better elucidate the mechanism for the observed improvement.