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Logo of aaciBioMed CentralBiomed Central Web Sitesearchsubmit a manuscriptregisterthis articleAllergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology
 
Allergy Asthma Clin Immunol. 2012; 8(Suppl 1): A17.
Published online Nov 2, 2012. doi:  10.1186/1710-1492-8-S1-A17
PMCID: PMC3487808
Effects of omalizumab on chronic urticaria not responding to recommended therapy
Jacques Hébertcorresponding author1,2 and Rose-Marie Caron-Guay1
1Centre de recherche appliquée en allergie de Québec, Québec City, Canada
2Allergie et Immunologie, CHUQ/Université Laval, Québec City, Canada
corresponding authorCorresponding author.
Jacques Hébert: hebert.j/at/videotron.ca
Supplement
Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2012
Publication of this supplement was supported by the CSACI.
Conference
Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2012
11-14 October 2012
Calgary, Canada
Background
Treatment of chronic urticaria consists of antihistamines as the first-line treatment. For more severe symptoms, combinations can be necessary as well as dose augmentations. The recent guidelines suggest the possibility of using omalizumab in resistant cases. We treated 2 patients with cold-urticaria (CO), 1 with cholinergic urticaria(CH) and 11 with chronic spontaneous urticaria (CSU) with omalizumab, who had not benefited from the recommended first-line, second-line and third-line treatments.
Patients were required to document their CU symptoms once daily with urticaria activity scores for 7 days (7UAS). Briefly, the symptoms were monitored in terms of numbers of wheals [none (=0 points), <10 (=1 point), 10–50 (=2 points), or >50 per day (=3 points)], and the intensity of their pruritus [none (=0 points), mild (=1 point), moderate (=2 points), severe (=3 points)], for a total of 42 points. To evaluate the efficacy of the omalizumab treatment, 7UAS obtained at baseline was compared to that at the third and sixth month of the therapy. Omalizumab was given at 150 μg/month irrespective of IgE levels and increased to 300 mg if needed (no response). The concomitant medication was slowly reduced according to clinical response.
Results
The 7UAS improved significantly in all severe urticaria patients with omalizumab as early as one month (not shown) after initiation of therapy and was sustained for the 6 month observation (Figure (Figure1).1). 7UAS in patient #8 was >30 previously but =0 at entry because treated with oral prednisone for >1year. The response was not satisfactory for patient # 10 and omalizumab increased to 300 mg after 6 months with a better clinical response (not shown). Along with the clinical improvement, the concomitant medications could also be reduced significantly in all patients except #10, particularly prednisone.
Conclusion
Our results show that omalizumab improves significantly recommended treatment-resistant urticaria patients (13/14) in terms of clinical symptomatology (7UAS) and drug reduction in a real life setting. None of the patients reported any adverse effect.
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