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Therapeutic strategy according to the differing patient response profiles to omalizumab in chronic spontaneous urticaria

Giménez Arnau AM1, Valero Santiago A2, Bartra Tomás J3, Jáuregui Presa I4, Labrador-Horrillo M5, Miquel Miquel FJ6, Ortiz de Frutos J7, Sastre J8, Silvestre Salvador JF9, Ferrer Puga M10

1Dermatology Department. Hospital del Mar. Institut Mar D´Investigacions Mèdiques. Universitat Autónoma de Barcelona, Barcelona (Spain).
2Allergy Unit. Pneumology Department. Hospital Clínic, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona (Spain). RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL).
3Allergy Unit. Pneumology Department. Hospital Clínic. Barcelona. Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona (Spain). RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL).
4Allergy Department. Hospital Universitario Basurto, Bilbao (Spain).
5Allergology Department. Hospital Universitari Vall d'Hebron, Barcelona (Spain). RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL).
6Dermatology Department. Hospital Arnau de Vilanova. Valencia (Spain).
7Dermatology Department. Hospital Universitario 12 de Octubre, Madrid (Spain).
8Allergology Department. Fundación Jiménez Díaz, Madrid (Spain).
9Dermatology Department. Hospital General Universitario de Alicante, Alicante (Spain).
10Department of Allergy and Immunology. Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Pamplona (Spain). 

J Investig Allergol Clin Immunol 2019; Vol. 29(5)
doi: 10.18176/jiaci.0323

Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life, which is why rapid disease control is essential. Symptomatic first-line treatment of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to four times. In patients who fail to respond to these higher doses of H1 antihistamines, treatment with omalizumab (up to 24 weeks) is recommended to achieve disease control. After this 24-week period, the patient response profile to omalizumab should be defined in order to identify refractory patients. The optimal management approach for refractory patients has not been established. In this context, the aim of the present expert consensus study involving a group of specialists (allergists and dermatologists) with specific expertise in treating urticaria was to define specific patient profiles based on their differing responses to omalizumab. Another objective was to develop a treatment algorithm based on the specific response profile. First, a comprehensive literature review was conducted. Then, a group meeting was held to discuss all issues related to the therapeutic management of these patients that had not been addressed in any previous studies. In all cases, the experts considered both the available evidence and their own clinical experience with omalizumab. We believe that implementation of this proposed algorithm will help to optimise the management of CSU patients who are refractory to antihistamine treatment, reduce disease-related costs, and improve QoL.

Key words: Chronic urticaria, Antihistamines, Omalizumab, Algorithm, Treatment.

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