Maintenance of Remission With Low-Dose Omalizumab in Long-Lasting, Refractory Chronic Urticaria

Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria

“…For these patients, alternative treatments such as cyclosporine A, dapson or omalizumab therapy are recommended [3]. The recommendation of anti-IgE treatment is supported by a recent small clinical trial [15] and a number of case reports [7,8,9,10,11,16,17]. In addition to these previously published reports, the presented cases strongly suggest that omalizumab is an effective treatment in patients with recalcitrant physical urticarias.…”

Omalizumab in chronic spontaneous urticaria: patient-tailored tapering or planned discontinuation?

“…Several tapering attempts have been documented in reallife clinical settings, namely decreasing the dose and prolonging the dosing interval. Romano et al 6 found that maintenance of remission with progressive dose tapering down to 150 mg per month and lengthening the interval beyond 28 to 30 days was not tolerated. Silva et al 7 reached a maximum 6-week interval in 3 of 7 patients treated with full-dose omalizumab.…”

Effects of omalizumab treatment on serum cytokine concentrations of atopic patients with chronic spontaneous urticaria: a preliminary report

“…In addition, because IgE binding to FceRI has been demonstrated to favor proliferation and survival of mast cells and to lower the threshold for mediator release (11), unavailability of IgE due to clearance by omalizumab obviously has negative consequences on these aspects of mast cell biology. When also taking into account clinical observation, hints for additional mechanisms of action can be deduced by the very rapid onset of action, effectiveness maintained well beyond the drug half-life and/or with suboptimal doses for complete IgE neutralization, and evidence of no inhibition of mast cell ability to degranulate in vivo (5,9). Besides, unlike with asthma, to achieve remission in chronic spontaneous urticaria, omalizumab dose and administration schedule need not to be calculated based on body weight and serum total IgE concentration (6,7).…”

“…To put it simply, by binding circulating free IgE, omalizumab prevents mast cell degranulation and downstream mediator effects (2). Since omalizumab has been suggested to be possibly beneficial for management of chronic spontaneous urticaria as well (3)(4)(5), randomized placebo-controlled trials have been carried out to assess efficacy of anti-IgE therapy in chronic spontaneous urticaria (6,7), culminating in its recent approval for this indication both in the U.S. and Europe. However, despite robust evidence on omalizumab effectiveness in chronic spontaneous urticaria, how this monoclonal antibody works in this setting is not yet fully understood.…”

“…vol 49, n 4, 171-175, 2017 ule proposed for allergic asthma, i.e., based on body weight and total serum IgE concentrations, was adopted. Omalizumab dose was increased in case of unsatisfactory response or slowly tapered off in case of remission, as previously detailed (5,9).…”