Omalizumab for previously treated chronic spontaneous urticaria

Abstract

Urticaria (also known as hives, welts or nettle rash) is a vascular reactioncharacterised by the transient appearance of raised, itchy lesions ('wheals')on the skin. It occurs when histamine and other chemicals are released from under the surface of the skin, causing tissues to swell. The lifetime prevalence of chronic urticaria in the UK is 0.5 1%, but approximately 15% of people experience urticaria at some time in their lives. For many people with urticaria, the cause of their condition is unknown. Individual wheals can change size rapidly and move around the skin, disappearing in one place and then reappearing somewhere else on the body. They generally appear on the skin for no longer than 24 hours; however, the condition may persist for several months. Angioedema (swelling of lips, hands and feet) may also be present. When symptoms are present for more than 6 weeks, the condition is considered to be chronic. Symptoms may persist for 3 5 years in approximately 50% of people, and for more than 10 years in 20% of people. Initial treatment of chronic spontaneous urticaria is a non-sedating H1- antihistamine (for example, cetirizine, levocetirizine, fexofenadine, loratadine, bilastine, desloratadine). Dose escalation of the antihistamine (2-fold and then 4-fold) may be required if the standard dose is ineffective. Subsequent treatment options for people whose condition does not respond to non- sedating antihistamines include leukotriene receptor antagonists, H2-receptor antagonists, immunosuppressant drugs (such as ciclosporin, mycophenolate mofetil and methotrexate) and tetrahydrofolate dehydrogenase inhibitors (such as dapsone). Oral corticosteroid pulses may be used to treat exacerbations.

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Identifiers

ORCID for Keith Cooper: orcid.org/0000-0002-0318-7670

ORCID for Joanna Picot: orcid.org/0000-0001-5987-996X

ORCID for Petra Harris: orcid.org/0000-0001-9257-3786

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