Omalizumab for severe chronic spontaneous urticaria: Real-life experiences of 280 patients

Chronic spontaneous urticaria (CSU) is a debilitating disorder.[...]well-defined therapeutic strategies are required to achieve a maximal remission and maintain quality of life.The first involves highly cytokinergic monomeric IgEs, which by binding Fc region of immunoglobulin E receptor I (FcɛRI) in the absence of antigens induce mast cell activation and histamine release.6 The second is the binding of autoreactive antibodies on activated skin mast cells.[...]we suggest that the fast onset of response to omalizumab could be explained by the rapid sequestration of monomeric-free IgEs and the silencing of mast cell degranulation.Hsieh, S. Saini, C. Grattan, A. Gimenez-Arnau, Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria, N Engl J Med, Vol. 368, 2013, 924-935 4 T. Zuberbier, W. Aberer, R. Asero, C. Bindslev-Jensen, Z. Brzoza, G.W. Canonica, 2, Allergy, Vol. 69, 2014, 868-887 5 M. Metz, T. Ohanyan, M.K. Church, M. Maurer, Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: a retrospective clinical analysis, J Dermato Sci, Vol. 73, 2013, 57-62 6 J. Kashiwakura, Y. Okayama, M. Furue, K. Kabashima, S. Shimada, C. Ra, Most highly cytokinergic IgEs have polyreactivity to autoantigens, Allergy Asthma Immunol Res, Vol. 4, 2012, 332-340 7 T.W. Chang, C. Chen, C.J. Lin, M. Metz, M.K. Church, M. Maurer, The potential pharmacologic mechanisms of omalizumab in patients with chronic spontaneous urticaria, J Allergy Clin Immunol, Vol. 135, 2015, 337-342 8 A.P. Kaplan, A.M. Gimenez-Arnau, S.S. Saini, Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria, Allergy, Vol. 72, 2017, 519-533 9 M. Maurer, S. Altrichter, T. Bieber, T. Biedermann, M. Brautigam, S. Seyfried, Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase, J Allergy Clin Immunol, Vol. 128, 2011, 202-209.e5