Anti-IgE (omalizumab) effective as single-drug therapy for chronic idiopathic urticaria

Objective: Report a clinical case in which Anti-IgE (omalizumab) effectiveness and security are pointed out evidencing omalizumab as a suitable alternative medication for Chronic Idiopathic urticaria  in non-responders to recommended conventional therapy (Antihistamines and corticosteroids).

Methods and Material:  *Case Report: A 35 year-old caucasian male suffering from generalized and extremely pruritic erythematous infiltrative hives during the previous 6 years on a daily basis together with facial angioedema fortnightly was referred to our Allergy Division. Daily Levocetirizine, Hydroxicine and Ranitidine were insufficient to relieve his cutaneous lesions, requiring systemic corticosteroids monthly resulting in lack of effectiveness. Cutaneous eruption and swelling is not clearly related either to food/drug intake or physical agents. Complementary tests: Blood cell count, Biochemistry, total IgE and Specific IgE to Anisakis, milk, egg, peanut and haddock, antithyroid autoantibodies, HBV, HCV and HIV serology; Urine analysis, stool ova and parasites exam as well as thorax radiography were performed.

Results: Blood Cell Count and Biochemistry taken from peripheral blood sample were both within normal range. Total IgE was 115,2 UI/ml. Specific IgE to Anisakis Simplex, milk, egg,peanut and haddock  was <0.35 KU/L; antithyroid autoantibodies, HBV, HCV and HIV serologies were negative; Urine analysis, Stool parasites exam and thorax radiography were normal. Due to these findings and regarding clinical symptoms, omalizumab treatment was initiated at a dose of 300 mg every 30 days, concerning total IgE levels and patient´s body weight. No adverse events were recorded related to drug administration. 15 days after the first dose, our patient evinces total absence of pruritus and cutaneous lesions, therefore waving antihistamines and corticoisteroid treatment. Three months after, he remains receiving Anti-IgE (omalizumab) treatment, not presenting new urticaria/angioedema episodes.

Conclusion: We report a case of a patient suffering from conventional treatment-refractory Chronic Idiopathic Urticaria, who is being both effective and securely controlled with omalizumab). Our Patient remains asymptomatic following monotherapy with omalizumab.