Treating refractory chronic spontaneous urticaria with omalizumab: Real life case series

Introduction: Patients with refractory chronic spontaneous urticaria (CSU) may pose a significant challenge to the treating physician. Although many studies have investigated the effects of omalizumab in refractory CSU, many issues remain unanswered. Aim: To describe our experience in treating refractory CSU with omalizumab in a real-life setting. Material and methods: We present a series of eight patients with refractory CSU treated with omalizumab during a 2-year period. Results: The average duration of CSU was 49.9 months (3-180). A high average 7-day Urticaria Activity Score (UAS7) of 31.3 (12-42) and a low average Urticaria Control Test (UCT) score of 4.1 (0-8) had been recorded before omalizumab therapy. Prior to omalizumab, all patients required fourfold dose of H1-anihistamines, montelukast and corticosteroids to achieve at least a partial disease control. Antimalarial was given to two patients and dapsone to three, with no response. Adverse effects of corticosteroids were noted in most patients. Patients received 150 mg or 300mg of omalizumab subcutaneously every 4 weeks, for at least 3 months. All patients responded well to omalizumab and discontinued corticosteroid therapy. There were no significant side effects during omalizumab treatment. Conclusion: Omalizumab is an effective corticosteroid sparing treatment, enabling disease control in patients with refractory CSU, even in lower doses (150 mg) and when given for a short period of time. This is especially important when the availability of the drug is determined by economic issues.