Many patients with chronic spontaneous urticaria treated with omalizumab were able to reduce their use of concomitant medications and achieve control of symptoms, according to the results of a real-world population study published in the Annals of Allergy, Asthma & Immunology.

A total of 48 patients with chronic urticaria treated with omalizumab for ≥1 year from clinics in Madison, Wisconsin, were enrolled in the study. The study initiated a protocol to allow reductions in omalizumab frequency and dosing, including changing the dosing frequency to every 6 weeks, 8 weeks, or 12 weeks, and the dose from 300 to 150 mg. In the overall cohort (mean age, 49 years), the mean omalizumab treatment duration was 38 months.

Approximately 30% (n=7) of patients reduced their cumulative dose of omalizumab, and 52% (n=12) of patients continued receiving the same dose. A total of 4 (17%) of patients had their omalizumab dose increased to maintain symptom control. Of the patients who had their doses decreased, 71% had a body mass index >31 kg/m2, and 43% had angioedema associated with urticaria. All patients who increased their cumulative dose of omalizumab were obese. Approximately 87% of patients achieved complete symptom control at the last clinic appointment.

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A high percentage of patients who took concomitant medications were able to stop or reduce the use of second-generation H1 blockers (48%), first-generation H1 blockers (62%), H2 blockers (65%), montelukast (63%), and daily corticosteroids (79%).

Limitations of the study included the small sample size, as well as the enrollment of patients from clinics within the same University of Wisconsin network.

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“For the practicing clinician,” the researchers wrote, “[these] data [support] a concerted clinical effort to tapering the dosage of omalizumab and other [chronic spontaneous urticaria] medications.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


McIntyre AP, Viswanathan RK, Moss MH, Mathur SK. Real world dosing of omalizumab for chronic spontaneous urticaria [published online December 2, 2019]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2019.11.028