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Therapeutic Strategy According to Differences in Response to Omalizumab in Patients With 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 and 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 and RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL)
4Allergy Department, Hospital Universitario Basurto, Bilbao, Spain
5Allergology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain and 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

J Investig Allergol Clin Immunol 2019; Vol 29(5) : 338-348
doi: 10.18176/jiaci.0323

Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life. Consequently, rapid disease control is essential. First-line treatment of the symptoms of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to 4 times. In patients who fail to respond to higher doses of H1 antihistamines, omalizumab for up to 24 weeks is recommended to achieve disease control. After this 24-week period, the patient’s response to omalizumab should be assessed in order to identify refractory patients. Optimal management of refractory patients has not been established. Therefore, the aim of the present consensus document, which was drafted by allergists and dermatologists with specific expertise in treating urticaria, was to define specific patient profiles based on differences in their response to omalizumab. We also developed a treatment algorithm based on the specific response profile. After a comprehensive literature review, a group meeting was held to discuss issues related to the therapeutic management of patients with CSU that had not been addressed in previous studies. The experts considered both the available evidence and their own clinical experience with omalizumab. We believe that implementation of the proposed algorithm will optimize management of CSU patients who are refractory to antihistamines, reduce disease-related costs, and improve quality of life.

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

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