medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-489medsovet-9654Research ArticleАЛЛЕРГОЛОГИЯ И ИММУНОЛОГИЯALLERGOLOGY AND IMMUNOLOGYДолгосрочная терапия и возможность управления дозами омализумаба у пациентов с хронической спонтанной крапивницей и частыми рецидивами: разбор клинического случаяLong-term therapy and the possibility of managing omalizumab doses in patients with chronic spontaneous urticaria and frequent relapses: Clinical case analysishttps://orcid.org/0009-0008-5345-7510ГромовА. С.GromovA. S.

Громов Алексей Сергеевич, врач аллерголог-иммунолог амбулаторно-консультативного отделения аллергологии и иммунологии

620149, Екатеринбург, ул. Серафимы Дерябиной, д. 34

Aleksey S. Gromov, Allergist-Immunologist at the Outpatient Consultation Department of Allergology and Immunology

34, Serafima Deryabina St., Ekaterinburg, 620149

gralser87@gmail.comhttps://orcid.org/0000-0002-5103-2446ПетуховаА. Ю.PetukhovaA. Yu.

Петухова Анна Юрьевна, к.м.н., заведующая амбулаторно-консультативным отделением аллергологии и иммунологии

620149, Екатеринбург, ул. Серафимы Дерябиной, д. 34

Anna Yu. Petukhova, Cand. Sci. (Med.), Head of the Outpatient Consultation Department of Allergology and Immunology

34, Serafima Deryabina St., Ekaterinburg, 620149

Центральная городская клиническая больница №6 города ЕкатеринбургаРоссияCentral City Clinical Hospital No. 6 of EkaterinburgRussian Federation202512122025020112117Copyright © Громов А.С., Петухова А.Ю., 20252025Громов А.С., Петухова А.Ю.Gromov A.S., Petukhova A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9654

Хроническая спонтанная крапивница (ХСК) является одним из самых распространенных кожных заболеваний. Пациентам, у которых не удается достигнуть контроля, в т. ч. эскалационными дозами антигистаминных препаратов (АГП), требуется генно-инженерная биологическая терапия (ГИБТ) омализумабом. В данной статье представлен клинический опыт персонифицированного подбора дозы и продолжительности применения биологической терапии для лечения и профилактики рецидивов заболевания у пациента с тяжелой рецидивирующей ХСК, что представляет интерес для практикующих врачей-аллергологов. Мужчина, 49 лет, в 2019 г. впервые обратился с жалобами на ежедневные генерализованные уртикарные высыпания. Показатель опросника оценки активности крапивницы за 7 дней (Urticaria Activity Score 7, UAS7) составил 42 балла, теста по оценке контроля крапивницы (Urticaria Control Test, UCT) – 0 баллов. Смена ранее проводимой терапии АГП на биластин 20 мг/сут, в т. ч. в эскалационных дозах 4 табл/сут, существенного эффекта не оказала. По результатам проведенных рутинных исследований отклонений от референсных значений не выявлено. В связи с отсутствием эффекта от вышеуказанного лечения была инициирована ГИБТ омализумабом 300 мг 1 раз в 4 нед. – 6 инъекций с положительным эффектом; через 1,5–2 мес. возник рецидив с возобновлением курса омализумаба 300 мг 1 раз в 4 нед., 12 инъекций; в дальнейшем из-за регулярно сохраняющихся рецидивов проведено еще 3 курса терапии омализумабом. При последующем ведении пациента для профилактики очередного прогнозируемого обострения врачебной комиссией лечебного учреждения было принято решение об использовании ГИБТ омализумабом в дозе 150 мг 1 раз в 4 нед. В данном клиническом случае продемонстрировано, что низкая доза омализумаба 150 мг была сопоставима со стандартной дозой 300 мг и также позволила достичь контролируемого течения заболевания. На основании собственного опыта авторов и анализа данных международных и отечественных медицинских исследований сделаны выводы о перспективах и обоснованности назначения ГИБТ омализумабом в дозе 150 мг 1 раз в 4 нед.

Chronic spontaneous urticaria (CSU) is one of the most common skin diseases. Patients who fail to achieve control, including with escalated doses of antihistamines (AH), require gene-engineered biological therapy (GIBT) with omalizumab. This article presents a clinical experience of personalized dosing and duration of biological therapy for the treatment and prevention of disease recurrences in a patient with severe recurrent CSU, which may be of interest to practicing allergists. A 49-year-old man first sought medical help in 2019 with complaints of daily, generalized urticarial eruptions. The Urticaria Activity Score 7 (UAS7) was 42 points, and the Urticaria Control Test (UCT) was 0 points. Switching from previous antihistamine therapy to bilastine 20 mg daily, including escalated doses of 4 tablets/day, did not produce a significant effect. Routine tests showed no deviations from reference values. Due to the lack of response to the above treatment, GIBT with omalizumab was initiated at 300 mg once every 4 weeks—6 injections with a positive effect. After 1.5–2 months, a relapse occurred, and the course of omalizumab 300 mg once every 4 weeks was resumed, totaling 12 injections. Subsequently, due to persistent recurrences, three more courses of omalizumab therapy were administered. In subsequent management, to prevent another predictable exacerbation, the medical team decided to use GIBT with omalizumab at a dose of 150 mg once every 4 weeks. This clinical case demonstrates that a low dose of omalizumab (150 mg) was comparable to the standard dose (300 mg) and also allowed for disease control. Based on the authors' own experience and analysis of international and domestic medical research data, conclusions were made regarding the prospects and justification for prescribing GIBT with omalizumab at a dose of 150 mg once every 4 weeks.

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The authors declare that there are no conflicts of interest present.