Omalizumab for the treatment of solar urticaria: case series and systematic review of the literature

Publication date: Available online 20 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Igor Snast, Noa Kremer, Moshe Lapidoth, Claes David Enk, Yuval Tal, Yossi Rosman, Ronit Confino-Cohen, Emmilia Hodak, Assi Levi
BackgroundLSolar urticaria (SU) is a rare photodermatosis causing a significant impact on patients' quality of life. Although the condition can be controlled with phototherapy and/or a combination therapy of antihistamines and leukotriene antagonist in most patients, a subset of patients require additional therapy with omalizumab; however, efficacy data is sparse.ObjectiveTo determine the efficacy and safety of omalizumab for treating SU.MethodsA case series of five patients with SU refractory to antihistamine and leukotriene antagonist combination who were treated with omalizumab is described. Additionally, a systematic review of studies evaluating SU patients treated with omalizumab was conducted. Primary outcome was partial/complete clinical response. Secondary outcomes were 10-fold decreases in the baseline minimal urticarial dose (MUD10) and adverse events.ResultsOur case series included five patients with SU. Monthly omalizumab doses of 150 - 600 mg resulted in clinical improvement in all patients and complete remission in four. No adverse effects were reported. The systematic review included 22 studies (48 patients). All patients failed to control disease with antihistamines prior to omalizumab treatment. Patients received omalizumab at monthly doses of 150 - 750 mg over a follow-up period of 4 - 200 weeks. Thirty-eight patients (79%) experienced clinical improvement. Four patients (11%) had mild adverse effects.ConclusionOmalizumab provided clinical benefits in approximately 80% of SU patients. Patients failing to improve on standard omalizumab doses may benefit from higher monthly dosages.