Biologic agents and the therapy of chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) has been traditionally managed with antihistamines. Over the years, studies using different formulations and dosing regimens have delineated the limits of their effectiveness, thus emphasizing the need for alternative therapeutic approaches. Data keep accumulating that the monoclonal anti-immunoglobulin E antibody omalizumab, until recently reserved for the treatment of severe atopic asthma, may have a beneficial therapeutic and safety profile for CSU cases resistant to the effect of antihistamines.

Since the beginning of 2013, a host of studies have been published paving the way for licensing of omalizumab for the treatment of CSU. Dose-finding studies have indicated 300 mg monthly as a possible optimal treatment regimen. Efficacy proving randomized controlled trials were further supported by open-label studies confirming its effectiveness in real life. One report has been published so far presenting positive data about the use of another biologic agent, rituximab, depleting the blood stream of B cells, in patients with CSU.

New convincing evidence in support of the efficacy and safety of omalizumab in the treatment of CSU has accumulated over the past year, providing another tool for coping with the antihistamine-resistant cases.