Chronic Spontaneous Urticaria and Omalizumab as an Emerging Therapy

Chronic spontaneous urticaria (CSU) is a debilitating condition that affects individuals for an extended period of time. Chronic urticaria is characterized by the presence of characteristic wheal and flare lesions for greater than six weeks. This inflammatory reaction is primarily mediated by histamine release from mast cell degranulation although multiple other physiologic factors are involved. CSU is a diagnosis of exclusion where definitive triggers are not identified, however, associations with autoimmune conditions have been investigated. Second-generation antihistamines are the recommended primary treatment for CSU, but a significant number of cases are refractory to conventional treatments. Omalizumab (Xolair) is an anti-IgE biologic agent recently approved by the Federal Drug Administration for the treatment of CSU. Studies have shown favourable safety profiles and efficacy. Omalizumab shows promise as an agent for the management of recalcitrant symptoms and overall improvement of quality of life.