Antihistamines and omalizumab combination treatment in patients with chronic spontaneous urticaria: Real-world experience from a tertiary care hospital.

Objective: Chronic spontaneous urticaria is characterized by recurrent hives and/or angioedema that persists for more than six weeks, with unknown triggers. This study aimed to gather and analyze real-world data from adult patients diagnosed with chronic spontaneous urticaria who were receiving omalizumab treatment.

Methods: This retrospective observational study included adults who received omalizumab between September 2022 and February 2024.

Results: A total of 64 patients were included in the study, with a mean age of 44.3 years. Among them, 40 (62.5%) were female, and 24 (37.5%) were male. The mean duration of urticaria diagnosis was 46.6 months, with a mean omalizumab use of 23.6 months. Prior to omalizumab treatment, the most commonly used treatments were the highest dose of second-generation antihistamines (60.9%), and combination therapy with antihistamines and oral corticosteroids (31.3%). All patients received omalizumab 300 mg once every four weeks from the start of treatment and continued using antihistamines. No significant correlation was observed between the antihistamine dosage and treatment response (p=0.06). An observed interval extension and/or dose increase was noted in 23.4% of the patients. The mean Urticaria Control Test (UCT) score, weekly Urticaria Activity Score (UAS7), and Dermatology Life Quality Index (DLQI) scores significantly improved from the first visit before omalizumab treatment to the last visit after treatment (all p<0.001). Of the patients, 98.4% responded moderately or above to the treatment, 26.6% responded thoroughly, and 46.9% responded well. Only three patients (3.1%) experienced myalgia as a side effect of omalizumab therapy, with no severe adverse events reported.

Conclusion: Combination therapy with antihistamine and omalizumab is a reliable and beneficial therapy for managing chronic spontaneous urticaria.