Effectiveness and tolerability of personalized omalizumab treatment in patients with chronic inducible urticaria

[...]published evidence of omalizumab in CIndU is limited to small case series and randomized controlled trials evaluating the standard dosing regimen (300 mg/4 wk).3 For CSU, there is increasing evidence that updosing of omalizumab is effective in patients who are unresponsive to the standard dose.4,5 At our center, antihistamine refractory CSU and CIndU patients with high disease activity are treated with omalizumab using a personalized treatment approach that includes updosing.6 The aim of this retrospective study was to evaluate the effectiveness and tolerability of this personalized treatment approach in various CIndU subtypes. To measure the effectiveness of omalizumab treatment, we used the Urticaria Control Test (UCT), a validated patient-reported outcome measure for both CSU and CIndU.7 The UCT questionnaire is composed of four questions about the control of urticaria; every answer is given a score from zero to four. [...]the outcome of the questionnaire can vary from zero to 16, in which zero indicates no control and 16, complete control. Subtype Patients, n Response after three standard administrations Response after personalized follow-up No control Partial control Good control Complete control No control Partial control Good control Complete control Including updosing Updosing successful∗ Successful dose level Delayed-pressure 13 0 5 4 4 0 3 5 5 2/13 0 – Cholinergic 12 2 4 5 1 0 4 7 1 5/12 4 2 × 450 mg, 2 × 600 mg Symptomatic dermatographism 8 2 3 2 1 2† 2 1 3 4/8 2 2 × 600 mg Cold 6 2 1 3 0 1‡ 2 2 1 1/6 1 450 mg Heat 4 2 0 2 0 1§ 0 2 1 1/4 1 450 mg Aquagenic 1 0 1 0 0 0 0 1 0 1/1 1 450 mg Total 44 8 14 16 6 4 11 18 11 14 9 Table I Overview of clinical response per subtype after three standard administrations of 300 mg omalizumab per 4 wk (T = 12 wk) and response after dose escalation during personalized follow-up phase, which could include updosing up to 450 mg/4 wk or 600 mg/4 wk