Omalizumab for Chronic Idiopathic Urticaria: Potential to Taper Dose and Frequency?

Omalizumab is FDA-approved for treatment of chronic idiopathic urticaria (CIU). There is limited data on the long-term use of omalizumab for CIU, particularly with regards to frequency, dosing, and potential for tapering its use. With an IRB-approved protocol, 48 adult patients diagnosed with chronic urticaria and treated with omalizumab were identified in the electronic medical record (EMR). 21 patients were excluded for having diagnosis of mastocytosis and/or less than 1 year of omalizumab use. Of the remaining 27 patients, clinic notes from the Allergy clinic were accessed to collect the following data: age, sex, BMI, omalizumab starting and current dose, frequency and use of additional medications before and after starting omalizumab. The 27 patients with CIU on omalizumab for at least 1 year (average duration 38 months) included 5 males and 22 females with an average age of 48 years. 70% of the patients in this study were obese (BMI ≥ 36). The average starting cumulative dose of omalizumab usage was 320 mg/4 weeks and the average current cumulative dose of omalizumab usage was 299 mg/4 weeks. 21 patients (81%) decreased or remained on the same dose of omalizumab. Overall, all patients had complete (85%) or almost complete (15%) urticaria symptom control. The majority of patients in this study remained on the same or decreased cumulative dosage of omalizumab for multiple years. All patients achieved complete or almost complete control of symptoms, suggesting an opportunity for tapering omalizumab dose and frequency.