Background: Omalizumab is a third-line treatment for chronic spontaneous urticaria (CSU). Studies investigating the use of higher doses of omalizumab in patients unresponsive to regular doses are limited. Objectives: This study aims to investigate the effectiveness and safety of omalizumab 450 mg in CSU. Methods: A retrospective cohort study was conducted. The response to therapy was evaluated using the Urticaria Activity Score over 7 days (UAS7) and the Urticaria Control Test (UCT). Patients showing complete response (CR) (UAS7: 0-1) to omalizumab 300 mg (Group 1) and patients receiving at least 3 doses of omalizumab 450 mg (Group 2) between 2016 and 2018 were included. Results: A total of 72 patients (Group 1: 59; Group 2: 13) were included. In Group 2, the mean UAS7 score decreased from 18.6 to 5.1 and the mean UCT score increased from 8.6 to 12 after a mean 4.3 courses of 450 mg omalizumab treatment. Of the 13 patients in Group 2, 6 had CR and 3 had good disease control (UAS7: 2-6). The rate of patients with low baseline IgE levels (< 43 IU/mL) was significantly higher in Group 2. Conclusions: Higher doses of omalizumab are effective and safe in patients with CSU that is unresponsive to omalizumab 300 mg. Lower baseline total IgE levels might be used as a predictor of nonresponse to omalizumab and the need for higher doses.

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Objectives: To evaluate the efficacy of topical clobetasol propionate 0.05% pomade in the treatment of idiopathic granulomatous mastitis. Patients and Methods: Twenty-one idiopathic granulomatous mastitis patients' clinical and histopathological findings were retrospectively reviewed. Those patients excluded from other etiologies were categorized as idiopathic granulomatous mastitis and treated with topical clobetasol propionate 0.05% pomade as an initial treatment. Results: All 21 patients with a final diagnosis of idiopathic granulomatous mastitis were women with the average age of 36.2+/-5.2 years. Of the 21 patients; erythema, induration and pain problems of 6 (28.5%) patients totally resolved without recurrence in 3 months follow-up period. Erythema, induration and pain problems of 7 (33.5%) patients were minimalized and stay stable in 3 months follow-up period. The symptoms of 8 (38%) did not change under topical clobetasol propionate treatment. None of the patients developed side or adverse effects due to topical steroid treatment and 6 of 18 patients with non-steroidal anti-inflammatory drugs (NSAIDs) complained of gastric pain. Conclusion:Topical steroid treatment is a safe treatment option for idiopathic granulomatous mastitis patients before systemic steroid and immunosuppressive treatments and also surgery.