Beyond the Rash: How Omalizumab Shapes Mental Health Outcomes in Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is defined as urticaria lasting at least 6 weeks. Its symptoms (itching, redness, wheals, etc.) significantly impair quality of life and psychological well-being. This study aimed to assess the effect of omalizumab on anxiety, depression, and stress in CSU patients.

This study prospectively evaluated patients diagnosed with CSU who were treated with six doses of omalizumab. A series of assessments were conducted prior to and following the administration of treatment. These included the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS: HADS-Anxiety [HADS-A] and HADS-Depression [HADS-D]), the Weekly Urticaria Activity Score (UAS7), and the Urticaria Control Test (UCT). The results for HADS-A and HADS-D were further classified as normal, borderline, or abnormal.

A total of 34 patients (8 males, 26 females) with a mean age of 38.5 ± 9.9 years were included in the study. Following treatment, 31 of 34 patients (91%) achieved notable reduction in the UAS7 score, aligning with the minimal clinically important difference (9.5-10.5) criteria. A significant decrease was observed in HADS and PSS scores, while a significant increase was noted in UCT scores (p < 0.001 for all parameters). A significant decrease in the UAS7 score was observed in all subcategories of the HADS-A and HADS-D assessments at the 6-month evaluation period. However, no significant change was observed between subcategories.

The omalizumab treatment has positive impact on urticaria activity, psychological parameters, and stress condition in CSU patients. The presence of anxiety and depression at baseline does not impact the efficacy of the treatment. Nevertheless, patients exhibiting elevated psychological stress or anxiety/depression scores in the absence of urticaria control should be referred for further psychiatric evaluation.