Chronic spontaneous urticaria treated with omalizumab: report of two cases

Background: Chronic spontaneous urticaria (CSU) is a relatively common skin disease whose etiopathogenesis, as well as other factors influencing disease manifestations, are not fully understood. Mast cell function is recognised as having a central role in CSU signs and symptoms. Therapeutic options are limited; a number of drugs, recommended by international guidelines for the management of urticaria, lack regulatory approval for CSU and are prescribed off label. Omalizumab, a recombinant humanized anti IgE antibody, has recently received the approval for CSU treatment in Europe after an appropriate clinical development. Patients and results: Two case reports, that describes our encouraging experience with this therapeutic option in a real-life setting are discussed and deeply investigate the different scenario for the omalizumab use. Conclusion: In both cases, a complete remission of CSU symptoms after omalizumab treatment are demonstrated. Moreover, 6 months therapy gave the better results, whit a relapse, in one subject, 1 month after discontinuing omalizumab. Accordingly, a better understanding of long-term safety and efficacy should be needed to allow long-term administration in responding patients through a changing in prescription rules.