title: Omalizumab in Chronic Spontaneous Urticaria: A Brazilian Real-Life Experience.
abstract: BACKGROUND
  Current guidelines on chronic spontaneous urticaria (CSU) suggest a treatment based on a 3-step approach that aims at total symptom control, starting with H1-antihistamines. However, a significant number of patients present an antihistamine-resistant urticaria that must be treated with an alternative third-line therapy such as omalizumab.
  
  
  METHODS
  Patients with a history of CSU who did not respond to treatment with high doses of modern antihistamines were treated with 150 or 300 mg of omalizumab every 4 weeks. The response to treatment was recorded as complete (CR), partial (PR) or no response. A dose adjustment was proposed according to response.
  
  
  RESULTS
  We treated 47 CSU patients with omalizumab (40 females), of whom 39.5% had evidence of autoimmunity. The average number of treatments was 11.4 (range 2-87). All patients had been refractory to high-dose modern antihistamines. A CR was seen in 84.6% of patients who started with 300 mg and in 60% of those who started with 150 mg. Only 1 patient had no response to both the 150- and 300-mg doses. In 6 of the PR patients with 150 mg, a higher dose of 300 mg was proposed and 4 had a CR. Four patients discontinued the treatment. No severe adverse events were reported in the patients who finished the study.
  
  
  CONCLUSIONS
  Although good results were seen in both groups, CR rates were higher in those under a high-dose initial treatment. Our data strongly suggest that the therapy should be individualized.
authors.affiliation: Federal University of Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Ensina
authors.forename: Solange Oliveira Rodrigues
authors.initials: SO
authors.lastname: Valle
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Juliani
authors.forename: Michel
authors.initials: M
authors.lastname: Galeane
authors.forename: Rosaly
authors.initials: R
authors.lastname: Vieira dos Santos
authors.forename: Luisa Karla
authors.initials: LK
authors.lastname: Arruda
authors.forename: Janaina Michelle Lima
authors.initials: JM
authors.lastname: Melo
authors.forename: Patrícia Karla
authors.initials: PK
authors.lastname: de Souza
authors.forename: Faradiba Sarquis
authors.initials: FS
authors.lastname: Serpa
authors.forename: Djanira Martins
authors.initials: DM
authors.lastname: de Andrade
authors.forename: Alfeu Tavares
authors.initials: AT
authors.lastname: França
authors.forename: Régis Albuquerque
authors.initials: RA
authors.lastname: Campos
authors.forename: Inês
authors.initials: I
authors.lastname: Camelo-Nunes
authors.forename: Dirceu
authors.initials: D
authors.lastname: Solé
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001938:Brazil; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D000069444:Omalizumab / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy* / Q000276:immunology*; D055815:Young Adult
chemical_list: D018926:Anti-Allergic Agents; D006633:Histamine Antagonists; D000069444:Omalizumab; D007073:Immunoglobulin E