Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria

Abstract

In physical urticaria, exogenous physical factors such as thermal triggers, solar radiation and mechanic triggers including friction or pressure are responsible for the elicitation of symptoms in the skin of patients. Avoidance of the respective stimulus is usually difficult or impossible, and many patients are not sufficiently treated with standard antihistamines. We report that treatment with omalizumab (Xolair®) of 7 patients with physical urticarias [solar urticaria (n = 2), urticaria factitia/symptomatic dermographism (n = 2), cold urticaria, delayed pressure urticaria and localized heat urticaria] resulted in complete symptom control within days after the first injection in 5 patients. In 1 patient, symptoms improved after increasing the dose of omalizumab, and 1 patient with localized heat urticaria did not respond significantly to treatment. Before anti-immunoglobulin E treatment, all patients had suffered from their physical urticaria for years and had had numerous unsuccessful therapies. The overall excellent responses to omalizumab treatment reported here indicate that anti-immunoglobulin E is a safe and effective treatment for recalcitrant physical urticarias.

Methods report on the development of the 2013 revision and update of the EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria

“…We thus recommend the use of OMA in those patients not responding to fourfold doses of new-generation oral H1-AHs based on RCTs showing an excellent risk/benefit ratio in this group of patients. There are numerous other case reports that support these observations (65)(66)(67)(68)(69). See Supporting Evidence in Table 20.…”

Chronic Inducible Urticaria: Part II

“…There is evidence that IL-1, IL-3, IL-6, and tumor necrosis factor alpha (TNF-α) play a role in the etiopathogenesis [12].…”

“…Type of the antihistamine can be changed, leukotriene antagonists and/or H2 antihistamines can be added [11]. Next two drugs in the treatment course are cyclosporine A and omalizumab [10,12].…”

Urticaria inducible: serie de casos y revisión de la literatura

“…Metz, et al, reportaron, en el 2011, el primer estudio de serie de casos de urticaria inducible tratada con omalizumab, con resultados satisfactorios (11). Sin embargo, todavía no se han hecho ensayos controlados para evaluar tratamientos diferentes a los antihistamínicos.…”