Updosed Omalizumab in Chronic Spontaneous Urticaria With or Without Symptomatic Dermographism

One-third of patients with chronic spontaneous urticaria (CSU) require treatment beyond the licensed dose of omalizumab, but real-world data on response and predictors of updosed omalizumab remain limited.

We evaluated response rates to updosed omalizumab in CSU patients with or without symptomatic dermographism (SD) and explored predictors of response to 450 mg every 4 weeks.

We retrospectively analyzed 57 patients (27 CSU, 30 CSU + SD) who were poorly responsive to or lost response at licensed-dose omalizumab (300 mg every 4 weeks). All received omalizumab 450 mg every 4 weeks for at least 3 months; selected patients were further escalated to 600 mg. Disease control was assessed using the Urticaria Control Test (UCT), with scores ≥12 indicating well-controlled disease. Baseline clinical and laboratory characteristics were compared between responders and nonresponders.

Overall, 71.9% of 57 patients achieved disease control with omalizumab 450 mg over 6 months. Among patients who remained poorly controlled, 10 were escalated to 600 mg, of whom 9 (90%) achieved disease control. Baseline UCT scores were higher in responders than nonresponders (9 vs. 7.5, p = 0.015). No significant differences were observed for age, BMI, total IgE, anti-TPO levels, or concomitant SD. Low baseline IgE did not preclude response to updosed treatment.

Omalizumab updosing to 450 mg or 600 mg every 4 weeks appears effective in CSU patients with inadequate response to licensed dosing. Higher baseline UCT scores may predict better response, whereas conventional poor-response biomarkers seem less informative in updosed regimens.