1487 Effectiveness of omalizumab in the treatment of cold urticaria

Tuesday, 7 December 2010
Background: The effectiveness of the humanized monoclonal antibody omalizumab in the treatment of physical urticaria has been demonstrated by a number of small studies and case reports. In this case study we sought to assess the effects of omalizumab in patients with acquired cold urticaria (ACU), unresponsive to standard treatment with high doses of antihistamines, montelukast and/or corticosteroids.
Methods:Four patients with ACU (three males, one female, median age = 34 years) with a critical stimulation time threshold (CSTT) at 3 minutes. Three out of the four cold urticaria patients had a history of systemic anaphylactic reactions after exposure to cold environment and episodes of urticaria-angioedema several times a week during the winter, spring and autumn.
Results:Treatment with omalizumamb, resolved symptoms in three out four patients with cold urticaria (time to clinical response 1.5 months). Only the patient with the lowest total IgE (4.1 IU/ml) had a mild response to treatment, although the CSST became negative on the second month of treatment. Conclusion:Treatment with omalizumab can be beneficial in selected patients with cold urticaria refractory to standard treatment with antihistamines and /or corticosteroids. Patients with low levels of total IgE may not respond adequately to treatment with Omalizumab.