Omalizumab Treatment in Chronic Inducible Urticaria: A Systematic Review of Published Evidence

Publication date: Available online 24 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcus Maurer, Martin Metz, Randolf Brehler, Uwe Hillen, Thilo Jakob, Vera Mahler, Claudia Pföhler, Petra Staubach, Regina Treudler, Bettina Wedi, Markus Magerl
BackgroundOmalizumab, a recombinant anti-IgE antibody, effectively treats chronic spontaneous urticaria. Evidence is lacking in chronic inducible urticarias (CIndUs), which are frequently H1-antihistamine resistant.ObjectiveWe aimed to determine, from the current published literature, the strength of evidence for omalizumab efficacy and safety in the treatment of CIndUs.MethodsWe performed a PubMed® search to identify evidence on omalizumab use in the following nine CIndU subtypes: symptomatic dermographism, cold urticaria, delayed pressure urticaria, solar urticaria, heat urticaria, vibratory angioedema, cholinergic urticaria, contact urticaria and aquagenic urticaria.Results43 trials, case studies, case reports and analyses were identified. Our review indicates that omalizumab has substantial benefits in various CIndUs. The evidence is strongest for symptomatic dermographism, cold urticaria and solar urticaria. Little/no evidence was available on vibratory angioedema, aquagenic and contact urticaria. Our review supports the rapid onset of action, demonstrated through early symptom control in most cases, sometimes within 24 hours. Many patients gained complete/partial symptom relief and substantially improved quality of life. Adverse events were generally low with omalizumab being well tolerated by most patients including children.ConclusionsA strong body of evidence supports the use of omalizumab in the treatment of patients with therapy-refractory CIndU. More data from randomised controlled studies are warranted.



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