Long-term therapy and the possibility of managing omalizumab doses in patients with chronic spontaneous urticaria and frequent relapses: Clinical case analysis

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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