Effectiveness of omalizumab in adolescent and adult patients with chronic idiopathic/spontaneous urticaria: a systematic review of ‘real-world’ evidence

Figures & data

Figure 1. Data identification, screening, eligibility and inclusion.

Table 1. Review of urticaria types evaluated, study design, patient characteristics, and effectiveness outcomes reported (stratified by urticaria type of study).

	Authors	Year	Country	Study design(per publication)	Censored cases	n	Comorbidities/conditions	Age in years (Mean ± SD)	Female (%)	Years since CIU/CSU diagnosis (Mean ± SD)	Prior Treatment(s)	Months of omalizumab treatment (Mean ± SD)	Starting dose omalizumab	Responder (yes/no)	Degree of response (complete, partial, none or refractory)	UAS	UAS7	UCT	DLQI	CU-Q2oL	Safety
CIU/CSU studies (n = 21)
	Iemoli et al. [42]	2010	Italy	Case study/case series		1	Angioedema	57 ± 0	100.00%	5 ± 0	Antihistamine corticosteroid cyclosporine IV immunoglobulin other immunomodulator	6 ± 0	300 mg Q2W	✔
	Vestergaard & Deleuran [43]	2010	Denmark	Case study/case series		2		45 ± 17	100.00%	6.5 ± 5	Antihistamine 100% cyclosporine 100% mycophenolate mofetil 100% corticosteroid 50% methotrexate 50% IV immunoglobulin 50% other immunomodulator 100%	7.3 ± 0.4	150 mg Q4W 50.0% 300 mg Q4W 50.0%				✔		✔
	Wieczorek et al [44].	2011	Germany	Case study/case series	10 total: 9 CindU, 1 with angioedema without hives	4					Antihistamine in combination with anti-leukotriene 100% corticosteroid 50%		doses, based on serum IgE, ranged from 150 mg Q4W to max dose 750 mg Q4W		✔
	Armengot-Carbo et al. [45]	2013	Spain	Retrospective		15		49 ± 49	73.30%	4.9 ± 6.5	H1-antihistamine 100% H2-antihistamine 80.0% corticosteroid 40% cyclosporine 33.3%	5 ± 1.5	150 mg Q2W 13.33% 150 mg Q4W 53.33% 300 mg Q4W 33.33%		✔						✔
	Song et al. [46]	2013	Canada	Retrospective		16		47.2 ± 13.7	68.70%	6.3 ± 4.7	Antihistamine 100% corticosteroid 81.3% various other 2nd &3rd line tx (% not reported)		150 mg Q4W 100%		✔						✔
	Kai et al. [47]	2014	UK	Retrospective	9 total: 8 with CindU, 1 with vasculitis	6					H1-antihistamine 100% cyclosporine 100% mycophenolate mofetil 100% methotrexate 100%	11.5 ± 9.4							✔		✔
	Romano et al. [48]	2015	Italy	Retrospective	3 with atopic dermatitis	6		53.2 ± 12.2	83.30%	5.7 ± 6.2	Antihistamine 100% corticosteroid 100% anti-leukotriene 83.3% cyclosporine 50%	32.8 ± 33.3	150 mg Q4W 33.33% 300 mg Q2W 33.33% 300 mg Q4W 33.33%		✔		✔				✔
	Tontini et al. [49]	2015	Italy	Prospective		8		47.5 ± 12.1	50.00%	6.5 ± 3.8	H1-antihistamine 100% corticosteroid 100% cyclosporine 37.5%	6 ± 0	300 mg Q4W 100%				✔
	Clark et al. [50]	2016	US	Retrospective		41	Angioedema 31.7%	43.8 ± 15.4	80.50%	4.8 ± 0	H1-antihistamine 100% corticosteroid 75.6% cyclosporine 51.2% methotrexate 36.6% anti-leukotriene 31.7% mycophenolate mofetil 26.8% dapsone 22.0% colchicin 14.6%	14.1 ± 6.4	150mg Q4W 19.5% 300mg Q2W 51.2% 300 mg Q4W 29.3%	✔							✔
	Denman et al. [51]	2016	UK	Retrospective		123						7 ± 4.5									✔
	Gimenez-Arnau et al. [52]	2016	Spain	Retrospective		38		48.1 ± 14	65.80%	6.6 ± 8.1	Antihistamine 100% corticosteroid 78.9% cyclosporine 39.5% anti-leukotriene 26.3%		300 mg Q4W 100%		✔		✔			✔	✔
	Gomez-Vera et al. [53]	2016	Mexico	Prospective	5 with CindU	21	Angioedema 76.2%	49.2 ± 9.1	85.70%	5.1 ± 1.2	Antihistamine 100%	6 ± 0	300 mg Q4W 100%				✔	✔			✔
	Gönül et al. [54]	2016	Turkey	Case study/case series		1	Angioedema 100%	37 ± 0	100.00%	2 ± 0	H1-antihistamine andcorticosteroid		300 mg Q4W								✔
	Konstantinou et al. [55]	2016	Greece	Case study/case series		3	Angioedema 100%	56.7 ± 16.7	100.00%	0.4 ± 0.13	Antihistamine 100% corticosteroid 100% montelukast 100%	4 ± 0					✔	✔			✔
	Moreira et al. [56]	2016	Portugal	Retrospective	1 with CindU	5	Angioedema 80%	34.4 ± 15.5	80.00%	9.2 ± 6.8	Antihistamine 80% corticosteroid 80% anti-leukotriene 20%	17.4 ± 1.1	300 mg Q4W 100%								✔
	Subramaniyan & Chopra [57]	2016	India	Case study/case series		4	Angioedema 25%	36.5 ± 11.2	25.00%	3 ± 1.4	Antihistamine 100% corticosteroid 100% cyclosporine 50%	1 ± 0	Single dose of 300 mg				✔		✔		✔
	Ertas et al. [58]	2017	Turkey	Prospective		93		35.9 ± 12.21	65.05%	4 ± 6.9		3 ± 0	300 mg Q4W 100%		✔
	Gericke et al. [59]	2017	Germany	Prospective		64		47 ± 15.5	71.90%	3 ± 9.93	H1-antihistamine 100%	3 ± 0	300 mg Q4W 100%	✔
	Kocaturk et al. [60]	2017	Turkey	Prospective		15		41.2 ± 13.5	69.70%	1.8 ± 3.3	Antihistamine 100%		All treated with either 150 mg Q2W or 300 mg Q4W	✔				✔			✔
	Kulthanan et al. [61]	2017	Thailand	Retrospective	1 with CindU	12		40.4 ± 13	66.70%	4.4 ± 2.3	Antihistamine 100%, anti-leukotriene100% corticosteroid 100% cyclosporine 100% hydroxychloroquine 16.7%	6.3 ± 2.6	150 mg Q4W 100%		✔		✔				✔
	Larrea-Baca et al. [62]	2017	Spain	Prospective		18		44.1 ± 18.52	72.20%								✔			✔	✔
CAU studies (n = 3)
	Kaplan et al. [21]	2008	US	Prospective		12		47.3 ± 12.1	66.70%	6.3 ± 9.3	Antihistamine 100%	4 ± 0	Dosed according to body weight and total serum IgE levels and administered every 2–4 weeks		✔	✔			✔
	Maspero et al. [22]	2009	Argentina	Case study/case series		1	Angioedema 100%	12 ± 0	100.00%	1.2 ± 0	Antihistamine, corticosteroidand anti-leukotriene	12 ± 0	150 mg Q4W		✔
	Al-Ahmad [63]	2010	Kuwait	Case study/case series		3	Angioedema 100%	37.3 ± 12.6	100.00%	4.3 ± 0.6	Antihistamine 100% corticosteroid 100% montelukast 100%	16 ± 0	300 mg Q4W 100%		✔	✔					✔
CU studies (n = 6)
	Korkmaz et al. [64]	2010	Germany	Case study/case series		1	Angioedema 100%	29 ± 0	0.00%	1 ± 0	Antihistamine corticosteroid anti-leukotriene cyclosporine	2 ± 0	300 mg Q2W		✔
	Ferrer et al. [65]	2011	Spain	Prospective		9	Angioedema 66.7%	43.8 ± 12.4	77.80%	6.6 ± 3	Antihistamines 100% corticosteroid 77.8% cyclosporine 22.2% Doxepin 22.2% anti-leukotriene 11.1% Proton pump inhibitor 11.1%		300 mg Q2W 11.1% 300 mg Q4W 55.6% 300 mg Q12W 33.3%		✔	✔
	Košnik et al. [66]	2014	Slovenia	Case study/case series	1 with CindU	3		50.3 ± 15		1.9 ± 2	Antihistamine 100% corticosteroid 66.7% cyclosporine 33.3% anti-leukotriene 66.7% methotrexate 33.3%	4.3 ± 4.9	150 mg Q4W 66.7% 150 mg Q6W 33.3%		✔						✔
	Har et al.^a [67]	2015	US	Retrospective		10		44.2 ± 13.1	50.00%	8.4 ± 7.4	Antihistamine + at least onealternative treatment 100% mycophenolate 60% tacrolimus 60% dapsone 40% hydroxychloroquine 30% anti-leukotriene 20% cyclosporine 10% IV immunoglobulin 10%	43.8 ± 33.6	150 mg Q4W 40.0% 300 mg Q4W 30.0% 375 mg Q2W 10.0% 375 mg Q4W 10.0% 450 mg Q2W 10.0%	✔	✔						✔
	Irani et al. [68]	2015	Lebanon	Prospective		14			85.70%			12 ± 0	300 mg Q4W 100%		✔						✔
	Seth & Khan [69]	2017	US	Retrospective		24		44 ± 12.75	77.00%	3.7 ± 9.21		15 ± 17	Most patients received 300 mg Q4W; other regimens included 150 mg Q4 and 375 mg Q2W		✔						✔
CI/CSU or CU with combordities studies (n = 51)
	Dreyfus & Randolph [70]	2006	US	Case study/case series		1	Angioedema, asthma, allergic rhinitis	32 ± 0	100.00%	2 ± 0	Antihistamine corticosteroid epinephrine anti-leukotriene cyclosporine budesonide	6 ± 0	300 mg at initial injection; all subsequent injections 150 mg	✔							✔
	Spector & Tan [18]	2007	US	Case study/case series		3	Angioedema 33% allergic rhinitis 33% asthma 33% Crohn’s disease 33%	35.7 ± 11	66.70%	8 ± 10.4	H1-antihistamine 100% corticosteroid 100% anti-leukotriene 100% 5-Lipoxygenase inhibitor 66.7% H2-antihistamine 66.7%	4 ± 2.8	300 mg Q2W 33.3% 375 mg Q2W 66.7%		✔
	Dreyfus [19]	2008	US	Case study/case series		1	Angioedema, allergies, asthma, thyroid auto-immunity	22 ± 0	100.00%		Antihistamine corticosteroid cyclosporine	6 ± 0		✔
	Godse [20]	2008	India	Case study/case series		1	Sarcoidosis, osteoporosis, bronchial asthma	45 ± 0	100.00%	10 ± 0	Antihistamine corticosteroid anti-leukotriene cyclosporine	2 ± 0	300 mg Q4W		✔
	Magerl et al. [71]	2010	Germany	Case study/case series		8	Angioedema 87.5% asthma 25.0% other allergies 50.0% CindU 12.5%	44.6 ± 8.5	87.50%	7.3 ± 4.9	H1-antihistamine 100%and either switchantihistamine or anti-leukotriene 100%		150 mg Q4W 14.3% 300 mg Q2W 28.6% 300 mg Q4W 42.9% 300 mg Q6W 14.3%				✔				✔
	Godse [72]	2011	India	Case study/case series		5	Asthma 40.0% dermographism 20.0%	45.2 ± 12.3	60.00%	10 ± 6.7	Antihistamine 100% corticosteroid 60% cyclosporine 20% herbal 20%	4 ± 0	300 mg Q2W 60.0% 300 mg Q4W 40.0%			✔					✔
	Groffik et al. [73]	2011	Germany	Case study/case series		9	Atopic dermatitis 33.3% CindU 22.2% angioedema 22.2% cholinergic urticaria 22.2% asthma 11.1% sinusitis 11.1%	41.8 ± 13.7	33.30%	11.8 ± 16.9	H1-antihistamine 100% corticosteroid 88.9% anti-leukotriene 66.7% H2-antihistamine 22.2% immunoglobulin 11.1%	2.3 ± 0.8	150 mg Q2W 11.1% 150 mg Q4W 44.4% 300 mg Q2W 33.3% 300 mg Q4W 11.1%		✔						✔
	Saavedra & Sur [74]	2011	US	Case study/case series		1	Asthma, allergic rhinitis and atopic dermatitis	51 ± 0	100.00%	3 ± 0	Antihistamine corticosteroid anti-leukotriene cyclosporine	7 ± 0	300 mg Q2W		✔						✔
	Sanchez-Machin et al. [75]	2011	Spain	Case study/case series		1	Angioedema, rhinoconjunctivitis, episodic asthma	35 ± 0	100.00%	9 ± 0	Antihistamine corticosteroid doxepin cyclosporine	4.5 ± 0	300 mg Q2W		✔
	Nam et al. [76]	2012	South Korea	Retrospective		26	Atopy 68% NSAID hypersensitivity 61.5% angioedema or CindU 50% anti-nuclear antibody 19.2% antithyroglobulin antibody 23.1% antimicrosomal antibody 7.7%	43.1 ± 8.4	46.20%	5.3 ± 6.1	Fourth-line therapy 100%	6 ± 0	dosed according to body weight and total serum IgE levels and administered every 2–4 weeks		✔	✔					✔
	Diez et al. [77]	2013	Colombia	Case study/case series		3	Vasculitis 100% angioedema 100% +plasma autologous serum 100% CindU 66.7%	44.3 ± 14.2	100.00%	16.3 ± 7.2	Antihistamine 100% anti-leukotriene 100% corticosteroid 66.7% immunosuppresant 66.7%	14 ± 4.4	150 mg Q4W 66.7% 300 mg Q4W 33.3%		✔						✔
	Labrador-Horrillo et al. [78]	2013	Spain	Retrospective		110	CSU 100% CAU 42.9% CindU 35.5% angioedema 6.4%	45 ± 14.25	66.40%		Antihistamine 76.4% corticosteroid 77.3% cyclosporine or tacrolimus 28.8% anti-leukotriene 13.6% Other (methotrexate, doxepin,H2-antihistamine, antimalarial,dapsone, etc.) 15.5%		150 mg Q2W 9.1% 150 mg Q4W 49.1% 300 mg Q2W 4.5% 300 mg Q4W 25.5% Other (150–300 mg Q6-24W) 11.8%		✔	✔					✔
	Lefevre et al. [79]	2013	Denmark	Case study/case series		14	Asthma 21.4% psoriatic arthritis & fibromyalgia 7.1% systemic lupus erythematosus 7.1%	43.4 ± 17.7	64.30%	6.4 ± 4.8	Antihistamine 100% corticosteroid 92.9% mycophenolate mofetil 71.4%cyclosporine 57.1%	14.6 ± 12	150 mg Q4W 57.1% 300 mg Q2W 7.1% 300 mg Q4W 35.7%	✔			✔		✔		✔
	Viswanathan et al. [80]	2013	US	Retrospective	2 total: 1 age 8, 1 with CindU	17	Autoimmunity 52.9% (remainder CU not further specified) angioedema 29.4%	41.3 ± 12.9	64.70%		Cyclosporine 52.9% tacrolimus 23.5% hydroxychloroquine 23.5% mycophenolate mofetil 11.8%	5.9 ± 4.5	150 mg Q2W 17.6% 187.5 mg Q2W 5.9% 225 mg Q2W 5.9% 300 mg Q2W 23.5% 300 mg Q4W 47.1%		✔						✔
	Fiorino et al. [81]	2014	Italy	Case study/case series		2	Pressure urticaria 50%	52 ± 2.8	100.00%	9 ± 2.8	Antihistamine 100% corticosteroid 100% immunosuppressant 100% anti-leukotriene 50%	34.5 ± 19.1	150 mg Q4W 50.0% 300 mg Q4W 50.0%		✔		✔				✔
	Metz et al. J Derm Sci. [82]	2014	Germany	Retrospective	21 with CindU (without comorbid CIU/CSU)	30	CindU 33.3%		72.50%		Antihistamine 100% (many had also received2nd and 3rd line therapy[cannot tease out rates foronly CSU pts])		150 mg Q2W 12.0% 150 mg Q4W 60.0% 225 mg Q4W 4.0% 300 mg Q4W 24.0% (reported in n = 25)		✔						✔
	Rottem et al. [83]	2014	Israel	Retrospective		43	Allergic rhinitis 9.3% asthma 14.0%	45 ± 12	69.80%	4.3 ± 4	Antihistamine 97.7% corticosteroid 88.4% cyclosporine 25.6% anti-leukotriene 9.3% Other (methotrexate,mycophenolate mofetil,azatioprine, etc.) 14.0%		150 mg Q4W 74.4% 300 mg Q4W 25.6%		✔						✔
	Uysal et al. [84]	2014	Denmark	Prospective	5 total: 1 age 10, 4 with CindU (without comorbid CIU/CSU)	22	DPU 18.2% urticaria factitia 13.6% heat contact urticaria 4.6% contact urticaria 4.6% asthma 22.73% allergic rhinitis 18.18% drug allergy 18.18% hypothyroidism 9.09% anaphylaxis 4.55%	34.6 ± 17.5	72.70%	6.7 ± 6.5	Antihistamine 100% corticosteroid 40.9% anti-leukotriene 50.0% azathioprine 36.4% cyclosporine 13.6% methotrexate 9.1% dapsone 9.1% mycophenolate mofetil 4.6% ultraviolet B light 4.6%	15.2 ± 10.1	150 mg Q2W 100%	✔		✔
	Van Den Elzen et al. [85]	2014	Netherlands	Case study/case series	1 with CindU	4	Angioedema 75% DPU 25% anaphylaxis 25%	50 ± 6.7	75.00%	5 ± 2.9	Antihistamine 100% corticosteroid 75% cyclosporine 50% anti-leukotriene 50% azathioprine 25%		150 mg Q4W 75.0% 300 mg Q4W 25.0%		✔						✔
	Vieira Dos Santos et al. [86]	2014	Not specified	Case study/case series		1	Pressure urticaria anddermographism special circumstance: pregnancy	37 ± 0	100.00%	11 ± 0	Antihistamine corticosteroid anti-leukotriene cyclosporine	60 ± 0	150 mg Q4W		✔						✔
	Ghazanfar & Thomsen [87]	2015	Denmark	Case study/case series		1	Special circumstance: pregnancy	32 ± 0	100.00%		Antihistamine azathiorprine prednisolone TNF-inhibitor	36 ± 0	150 mg Q2W		✔						✔
	Klossowski et al. [88]	2015	Germany	Case study/case series		1	Acquired angioedema due to C1 inhibitor deficiency (C1-INH-AAE) and chronic lymphatic B cell leukemia 100%	57 ± 0		0.25 ± 0	Antihistamine corticosteroid		300 mg Q4W		✔
	Leiva-Salinas et al. [89]	2015	Spain	Case study/case series		1	HCV	49 ± 0	100.00%	0.42 ± 0	Antihistamine corticosteroid anti-leukotriene	8 ± 0	150 mg Q2W	✔							✔
	Lundberg et al. [90]	2015	US	Case study/case series		2	APECED 100%	12.5 ± 0.71	100.00%		Antihistamine 100% anti-leukotriene 100% doxepin 50%		150 mg Q4W		✔
	Netchiporouk et al. [91]	2015	Canada	Case study/case series	3 age <12	1	DPU	16 ± 0	0.00%	8 ± 0	Antihistamine anti-leukotrienes		300 mg Q4W		✔		✔
	Savic et al. [92]	2015	UK	Retrospective		46	CindU 21.7% angioedema 82.6% allergic condition 19.6% asthma 15.2% eczema 15.2%	43.3 ± 13.1	78.30%	3.8 ± 4.7	Antihistamines 100% corticosteroid 74.4% cyclosporine 71.7% leukotriene antagonists 50.0% methotrexate 37.0% mycophenolate mofetil 26.1% H2-antihistamines 21.7% tacrolimus 4.3%		150 or 300 mg Q2, 3 or 4W				✔		✔		✔
	Silva et al. [93]	2015	Portugal	Retrospective		7	Allergic asthma 42.9% allergic rhinitis 71.4%	40.6 ± 8	85.70%	6.9 ± 5.8	H1-antihistamine 100% H2-antihistamine 100% anti-leukotriene 100% corticosteroid 100% immunoglobulin 57.1% cyclosporine 42.9%	35 ± 2.75	150 mg Q2W 14.3% 150 mg Q4W 14.3% 225 mg Q2W 14.3% 225 mg Q4W 14.3% 300 mg Q2W 14.3% 300 mg Q4W 28.5%		✔	✔					✔
	Sussman et al. [94]	2015	Canada /Portugal	Case study/case series		3	DPU 33.3%	61.7 ± 17	33.30%	10.7 ± 7.6	Antihistamine 100% corticosteroid 100% anti-leukotriene 66.7% cyclosporine 66.7% immunoglobulin 66.7%	17 ± 16.5^b	150 mg Q4W 100%		✔						✔
	Wieder et al. [95]	2015	Not specified	Case study/case series		1	Asthma, angioedema, analphylaxis	51 ± 0	100.00%	3 ± 0	Antihistamine corticosteroid anti-leukotriene cyclosporine mycophenolate mofetil	29 ± 0	300 mg Q4W	✔							✔
	Bongiorno et al. [96]	2016	Italy	Case study/case series		14	Angioedema 50.0% asthma 28.6% atopic diathesis 28.6% CindU 14.3% IBS 7.1% contact dermatitis 7.1% psoriasis 7.1% autoimmune thyroiditis 7.1%	44.4 ± 15	64.30%	6 ± 7.9	Antihistamine 100% corticosteroid 78.6% cyclosporine 42.9% anti-leukotriene 14.3%	5.4 ± 2.7	300 mg Q4W 100%		✔		✔				✔
	Cuervo-Pardo et al. [97]	2016	US	Case study/case series		4	Special circumstance: pregnancy 100% asthma 75% allergic rhinitis 50%	Between 25 and 28	100.00%		H1-antihistamine 100% H2-antihistamine 100% anti-leukotriene 100% corticosteroid 100% immunosuppressant 75%	18.5 ± 5	300 mg Q4W 100%	✔							✔
	Dawicka et al. [98]	2016	Poland	Case study/case series		2	Hashimoto’s disease 50%	55 ± 12.7	100.00%	2 ± 0	Antihistamine 100% corticosteroid 100% anti-leukotriene 50% methotrexate 100%	3.3 ± 1.4	300 mg Q4W 100%				✔
	Ensina et al. [99]	2016	Brazil	Retrospective		47	CindU 21.3% autoimmunity 39.5%	38.9 ± 14.5	85.10%	4.5	Antihistamine 100% cyclosporine 4.3%		150mg Q4W 44.7% 300mg Q4W 55.3%		✔						✔
	Ertaş et al. [100]	2016	Turkey	Case study/case series		46	drug allergy 6.5% atopy 6.5% asthma 2.2% psoriasis 2.2% allergic rhinitis 2.2%	47 ± 13.4	50.00%	10.3 ± 8.6			300 mg Q4W 100%								✔
	Ghazanfar et al. [101]	2016	Denmark	Retrospective	17 with CindU	137	Angioedema 30.7% + histamine release test 34.3% other ‘significant comorbidities’ (including asthma, diabetes, HTN and hypothyroidism) 22.6%	39.7 ± 15	70.80%	3.8 ± 5.4	Anti-leukotriene 5.1% corticosteroid 42.3% immunosuppressant 27.0%		150 mg Q2W 45.3% 300 mg Q4W 54.7%		✔						✔^c
	Gozdzik-Spychalska et al. [102]	2016	Poland	Case study/case series		1	Asthma, idiopathic thrombocytopenic purpura	38 ± 0	100.00%	2 ± 0	Antihistamine 100% corticosteroid LABA anti-leukotriene theophylline SABA	36 ± 0	450 mg Q2W		✔						✔
	Kasperska-Zajac et al. [103]	2016	Poland	Retrospective		9	Angioedema only 66.7% DPU only 11.1% angioedema and DPU 22.2%	41.4 ± 15.1			Antihistamine 100% corticosteroid 100% anti-leukotriene 44.4% cyclosporine 22.2% methotrexate 11.1% other immunosuppressive/immunomodulatory 11.1%		300 mg Q4W 100%		✔						✔
	Olszowiec-Chlebna et al. [104]	2016	Poland	Case study/case series		1	Angioedema and idiopathic anaphylaxis	15 ± 0	100.00%	2 ± 0	Antihistamine corticosteroid self-injectable epinephrine	6 ± 0	300 mg Q4W		✔						✔
	Osmenda et al. [105]	2016	Poland	Case study/case series		1	Atopic asthma, allergic rhinitis	44 ± 0			Antihistamine fluticasone/salmeterol theophylline anti-leukotriene SABA methylprednisolone	29 ± 0	150 mg Q1W due to severe bronchial asthma		✔						✔
	Palacios et al. [106]	2016	US	Retrospective		41	Hypothyroidism 19.5% thyroid autoantibodies 19.5%	45.9 ± 17	80.50%		Antihistamine 100%		300 mg Q4W 100%	✔
	Shahzad H. [107]	2016	Pakistan	Case study/case series		1	Allergic rhinitis	52 ± 0	0.00%	15 ± 0	Antihistamine mast cell stabilizers corticosteroid anti-leukotriene xylometazoline nasal drops	12 ± 0	300 mg Q4W				✔			✔	✔
	Wilches et al. [108]	2016	Ecuador	Retrospective		26	Asthma 3.8% rhinitis 11.5%	47.8 ± 19.5	57.70%	1.9 ± 2.9	Antihistamine 100% corticosteroid 53.8% immunotherapy 3.8%	2.2 ± 1.6	150 mg Q4W 100%		✔	✔					✔
	Asero et al. [109]	2017	Italy	Prospective		32	Angioedema 37.5% thyroid autoimmunity 25% antinuclear antibody+ 15.6% NSAID-related exacerbations 12.5%	50.4 ± 18.5	65.60%	3.6 ± 3.2	Antihistamine 100% corticosteroid 71.9% cyclosporine 25% H2-antihistamine 9.4%	3 ± 0	300 mg Q4W 100%		✔
	Chicharro et al. [110]	2017	Spain	Case study/case series		1	HBV	56 ± 0	100.00%	15 ± 0	H1-antihistamine corticosteroid	6 ± 0	300 mg Q4W				✔				✔
	Deza et al. [111]	2017	Spain	Prospective		47	CindU 25.5% angioedema 42.6% +autologous serum skin test 68.2%	51 ± 5.75	78.70%	1.33 ± 3.58	Antihistamine 100% cyclosporine 53.2%	11 ± 0	300 mg Q4W 100%	✔
	Gonzalez-Medina et al. [112]	2017	Spain	Case study/case series		2	Special circumstance: pregnancy 100%	37 ± 0	100.00%	12.5 ± 6.4	Antihistamine 100% corticosteroid 100% cyclosporine 100%	19 ± 18.4	300 mg Q4W				✔				✔
	Iemoli et al. [113]	2017	Italy	Case study/case series		1	HIV	56 ± 0	0.00%	3 ± 0	Antihistamine cyclosporine	12 ± 0	150 mg Q4W				✔			✔	✔
	Marin-Cabanas et al. [114]	2017	Spain	Retrospective		16	CindU 45% angioedema 40% an autoimmune disease 20% atopy 17% HBV or HCV 4%	47.3	62.00%	1.9 ± 1.6	Second-line treatments 75% third-line treatments (including cyclosporine) 25%		doses ranged from 150 mg Q4W to 375 mg Q2W	✔							✔
	Pinto Gouveia et al. [115]	2017	Portugal	Prospective		13	angeioedema 100% DPU 53.8% Solar urticaria 7.7% atopy 7.7% psoriasis 7.7%	49.3 ± 16.2	84.62%	9.4 ± 10.1		15.3 ± 10.9	150 mg Q4W 100%		✔		✔				✔
	Porcaro et al. [116]	2017	Italy	Case study/case series		1	Chronic rhinosinusitis and severe asthma	15 ± 0	100.00%		Inhaled budesonide formoterol anti-leukotriene loratadine intranasal fluticasone furoate corticosteroid	6 ± 0	300 mg Q4W		✔		✔
	Türk et al. [117]	2017	Turkey	Retrospective		25	Asthma 16% rheumatologic disorder 4%	39 ± 12.74	72.00%	3.67 ± 3.52		6 ± 4.44	300 mg Q4W 100%		✔	✔					✔
Mixed studies (n = 3)
	Buyukozturk et al. [118]	2012	Turkey	Not specified		14	Mixed urticarias: CSU 85.7% idiopathic angeioedema 14.3% Comorbid: asthma 14.3% CSU & angioedema 7.1%	43.1 ± 9.8	71.40%	9.3 ± 8.5	Antihistamine 100% cyclosporine 21.4%	9.3 ± 4.1	150 mg Q4W 28.6% 225 mg Q4W 7.1% 300 mg Q2W 14.3% 300 mg Q4W 35.7% 375 mg Q2W 7.1% 375 mg Q4W 7.1%				✔			✔	✔
	Metz et al. JAMA Derm.^d [119]	2014	Germany	Retrospective		25	Mixed urticarias: CSU 36.0% CindU 40.0% CSU & CindU 24.0%	45 ± 14	72.00%		100% previously treated with omalizumab (with ≥90% improvement in symptoms without the need for concurrent antihistamines) with relapse of urticaria symptoms despite antihistamine treatment		Doses ranged from 150 to 600 mg Q2–4W		✔						✔
	Sussman et al. [120]	2014	Canada	Prospective	6 with CindU	62	Mixed urticarias: CSU 98.4% urticarial vasculitis 1.6%	44.7 ± 17.75	73.50%		Antihistamine 100% corticosteroid 97.1% anti-leukotriene 16.2% cyclosporine 10.3% hydroxychloroquine or methotrexate 20.6%	8.2 ± 7	150 mg Q2W 1.6% 150 mg Q4W 83.9% 300 mg Q4W 14.5%		✔		✔				✔

APECED: autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy; CAU: chronic autoimmune urticaria; CindU: chronic inducible urticaria; CIU/CSU: chronic idiopathic/spontaneous urticaria; CU-Q2oL: Chronic Urticaria and Quality of Life Questionnaire; CU: chronic urticaria; DLQI: Dermatology Life Quality Index; DPU: delayed pressure urticaria; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; HTN: hypertension; ISB: irritable bowel syndrome; NSAID: nonsteroidal anti-inflammatory drug; SD: standard deviation; UAS: Urticaria Activity Score; UAS7: Urticaria Activity Score 7; UCT: Urticaria Control Test.

^aFrom 2005 to 2015, 17 patients with refractory CU were placed on a trial of omalizumab. Ten patients (58.8%) responded and 7 (41.2%) did not. This report is on the 10 responders who were treated ≥1 year.

^bOmalizumab treatment duration missing for one patient (case #2); however, duration for this patient was reported in a separate case study [Sussman GL, Hebert J, Simons ER. A 63-year-old man with chronic spontaneous urticaria. CMAJ. 2016;188(4):279–283.] and is included here.

^cSafety data are for the entire sample of n = 154 patients as the safety data on the 17 censored CindU patients could not be teased apart.

^dThe sample of n = 25 patients comprises a subset of patients who were previously treated and achieved complete response, as reported in Metz et al. 2014 J Derm Sci, who then subsequently relapsed. Results from 2014 JAMA Derm are unique and are related to re-treatment with omalizumab.

Table 2. Summary of characteristics of studies included in the systematic review.

	Studies	%
Study design (as identified by authors)
Prospective study	14	16.7%
Retrospective study	26	31.0%
Case study/case series	43	51.2%
Not specified	1	1.2%
Subjects included^a
n = 1	22	26.2%
n = 2–4	15	17.9%
n = 5–14	18	21.4%
n = 15–29	13	15.5%
n = 30–44	6	7.1%
n = 45–137	10	11.9%
Urticaria subtypes included
Chronic idiopathic/spontaneous urticaria (CIU/CSU)	21	25.0%
Chronic auto-immune urticaria (CAU)	3	3.6%
Chronic urticaria not further specified (CU)	6	7.1%
CIU/CSU or CU with comorbidities	51	60.7%
Mixed	3	3.6%
Regions^b
Asia	15	17.6%
Europe	46	54.1%
North America	18	21.2%
South America	4	4.7%
Not specified	2	2.4%

^aSee Table S1 in Supplemental materials for detail.

^bSee Table S2 in Supplemental materials for detail. One study included subjects from both Canada and Portugal and is counted twice. Turkey and Israel are classified as Asia.

CAU: chronic autoimmune urticaria; CIU/CSU: chronic idiopathic/ spontaneous urticaria; CU: chronic urticaria not further specified.

Table 3. Summary of demographics and clinical treatments of patients.

	Studies	Patients	Mean ± SD
Age (years)	78	1326	43.7 ± 14.6
Years since diagnosis of urticaria	66	1038	4.8 ± 5.1
Duration of omalizumab treatment (months)	61	840	8.4 ± 6.1
Omalizumab starting dose(mg/month)	72	1117	280.8 ± 74.5
Titrated omalizaumab dose(mg/month)	26	302	255.5 ± 112.8
	Studies	Patients	N	%
Female gender	77	1360	960	70.6%
Omalizumab initial dose	71	1188
150 mg Q2W			108	9.1%
150 mg Q4W			301	25.4%
300 mg Q2W			50	4.2%
300 mg Q4W			696	58.5%
Other^a			33	2.8%
Titrated omalizaumab dose	26	302
150 mg Q2W			5	1.6%
150 mg Q4W			108	35.8%
300 mg Q2W			31	10.3%
300 mg Q4W			91	30.1%
Other^a			67	22.2%
Prior treatments
Antihistamines	75	1010	982	97.2%
Corticosteroids	70	1016	560	55.1%
Cyclosporine	66	870	256	29.4%
Anti-leukotrienes	69	1009	184	18.2%
Methotrexate	61	638	48	7.5%
Mycophenolate mofetil	62	797	51	6.4%
IV-immunoglobulins	63	701	12	1.7%
Tacrolimus	62	797	12	1.5%
Other immunomodulators	69	916	90	9.8%

mg: milligrams; Q: ‘quaque’ or every; SD: standard deviation; W: weeks.

^aSee Table S3 in Supplemental materials for specification of other initial and titrated doses.

Table 4. Review of clinical outcomes and treatment response rates (stratified by urticaria type of study).

			Initial responder		Final responder		Initial response			Final response			UAS
	Authors	Year	Responder	Nonresponder	Responder	Nonresponder	Complete	Partial	None	Complete	Partial	None	PRE (mean ± SD)	EOS (mean ± SD)	Change PRE-EOS	% Change PRE-EOS
CIU/CSU studies (n = 21)
	Iemoli et al. [42]	2010	100.0%	0.0%	100.0%	0.0%
	Vestergaard & Deleuran [43]	2010
	Wieczorek et al [44].	2011								75.0%	0.0%	25.0%
	Armengot-Carbo et al. [45]	2013					20.0%	60.0%	20.0%	66.7%	20.0%	13.3%
	Song et al. [46]	2013					87.5%	0.0%	12.5%	68.8%	0.0%	31.3%
	Kai et al. [47]	2014
	Romano et al. [48]	2015								66.7%	0.0%	33.3%
	Tontini et al. [49]	2015
	Clark et al. [50]	2016	82.9%	17.1%	90.2%	9.8%
	Denman et al. [51]	2016
	Gimenez-Arnau et al. [52]	2016								83.8%	6.5%	9.7%
	Gomez-Vera et al. [53]	2016
	Gönül et al. [54]	2016
	Konstantinou et al. [54]	2016
	Moreira et al. [56]	2016
	Subramaniyan & Chopra [57]	2016
	Ertas et al. [58]	2017								47.3%	38.7%	14.0%
	Gericke et al. [59]	2017			87.5%	12.5%
	Kocaturk et al. [60]	2017	66.7%	33.3%	84.6%	15.4%
	Kulthanan et al. [61]	2016					50.0%	25.0%	25.0%	75.0%	8.3%	16.7%
	Larrea-Baca et al. [62]	2017
CAU studies (n = 3)
	Kaplan et al. [21]	2008								58.3%	33.3%	8.3%	7.5 ± 1.78	2.66 ± 3.31	−4.84	64.5%
	Maspero et al. [22]	2009					0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
	Al-Ahmad [63]	2010								100.0%	0.0%	0.0%	5.47 ± 0.34	0.47 ± 0.53	−5	91.5%
CU studies (n = 6)
	Korkmaz et al. [64]	2010					0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
	Ferrer et al. [65]	2011								44.4%	55.6%	0.0%	6 ± 0.74	0 ± 1.48	−6	100.0%
	Košnik et al. [66]	2014								100.0%	0.0%	0.0%
	Har et al.^a [67]	2015	100.0%	0.0%						80.0%	20.0%	0.0%
	Irani et al. [68]	2015								71.4%	21.4%	7.1%
	Seth & Khan [69]	2017								57.7%	19.2%	23.1%
CI/CSU or CU with combordities studies (n = 51)
	Dreyfus & Randolph [70]	2006			100.0%	0.0%
	Spector & Tan [18]	2007								100.0%	0.0%	0.0%
	Dreyfus [19]	2008			100.0%	0.0%
	Godse [20]	2008					0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
	Magerl et al. [71]	2010
	Godse [72]	2011											5.1 ± 0.2	0.4 ± 0.5	−4.7	92.2%
	Groffik et al. [73]	2011								100.0%	0.0%	0.0%
	Saavedra & Sur [74]	2011					0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
	Sanchez-Machin et al. [75]	2011								100.0%	0.0%	0.0%
	Nam et al. [76]	2012								84.6%	7.7%	7.7%	4.84 ± 0.79	1.08 ± 1.69	−3.76	77.7%
	Diez et al. [77]	2013								66.7%	33.3%	0.0%
	Labrador-Horrillo et al. [78]	2013								81.8%	10.9%	7.2%	5.34 ± 0.88	0.66 ± 1.3	−4.68	87.6%
	Lefevre et al. [79]	2013	92.9%	7.1%
	Viswanathan et al. [80]	2013								52.9%	41.2%	5.9%
	Fiorino et al. [81]	2014								100.0%	0.0%	0.0%
	Metz et al. J Derm Sci. [82]	2014								83.0%	10.0%	7.0%
	Rottem et al. [83]	2014								48.8%	37.2%	14.0%
	Uysal et al. [84]	2014			86.4%	13.6%							6 ± 0	1.5 ± 2.2	−4.5	75.0%
	Van Den Elzen et al. [85]	2014								75.0%	0.0%	25.0%
	Vieira Dos Santos et al. [86]	2014					100.0%	0.0%	0.0%	100.0%	0.0%	0.0%
	Ghazanfar & Thomsen [87]	2015								100.0%	0.0%	0.0%
	Klossowski et al. [88]	2015					0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
	Leiva-Salinas et al. [89]	2015			100.0%	0.0%
	Lundberg et al. [90]	2015								100.0%	0.0%	0.0%
	Netchiporouk et al. [91]	2015								100.0%	0.0%	0.0%
	Savic et al. [92]	2015
	Silva et al. [93]	2015								100.0%	0.0%	0.0%	5.3 ± 1	0 ± 0	−5.3	100.0%
	Sussman et al. [94]	2015								100.0%	0.0%	0.0%
	Wieder et al. [95]	2015			100.0%	0.0%
	Bongiorno et al. [96]	2016								35.7%	50.0%	14.3%
	Cuervo-Pardo et al. [97]	2016			100.0%	0.0%
	Dawicka et al. [98]	2016
	Ensina et al. [99]	2016					72.3%	25.5%	2.1%	72.3%	25.5%	2.1%
	Ertaş et al. [100]	2016
	Ghazanfar et al. [101]	2016								67.0%	22.0%	11.0%
	Gozdzik-Spychalska et al. [102]	2016					100.0%	0.0%	0.0%	100.0%	0.0%	0.0%
	Kasperska-Zajac et al. [103]	2016								66.7%	22.2%	11.1%
	Olszowiec-Chlebna et al. [104]	2016								100.0%	0.0%	0.0%
	Osmenda et al. [105]	2016								100.0%	0.0%	0.0%
	Palacios et al. [106]	2016			70.7%	29.3%
	Shahzad [107]	2016
	Wilches et al. [108]	2016					7.7%	15.4%	76.9%	75.0%	0.0%	25.0%	5.6 ± 0.6	2 ± 2	−3.6	64.3%
	Asero et al. [109]	2017								56.3%	21.9%	21.9%
	Chicharro et al. [110]	2017
	Deza et al. [111]	2017			80.9%	19.1%
	Gonzalez-Medina et al. [112]	2017
	Iemoli et al. [113]	2017
	Marin-Cabanas et al. [114]	2017			100.0%	0.0%
	Pinto Gouveia et al. [115]	2017								30.8%	61.5%	7.7%
	Porcaro et al. [116]	2017					100.0%	0.0%	0.0%	100.0%	0.0%	0.0%
	Türk et al.^b [117]	2017								32.0%	60.0%	8.0%	6 ± 0.37	1 ± 0.96	−5	83.3%
Mixed studies (n = 3)
	Buyukozturk et al. [118]	2012
	Metz et al. JAMA Derm. [119]	2014								100.0%	0.0%	0.0%
	Sussman et al. [120]	2014					57.1%	39.9%	3.2%	66.1%	25.8%	8.1%
			UAS7				UCT				DLQI				CU-Q2oL
	Authors	Year	PRE (mean ± SD)	EOS (mean ± SD)	Change PRE-EOS	% Change PRE-EOS	PRE (mean ± SD)	EOS (mean ± SD)	Change PRE-EOS	% Change PRE-EOS	PRE (mean ± SD)	EOS (mean ± SD)	Change PRE-EOS	% Change PRE-EOS	PRE (mean ± SD)	EOS (mean ± SD)	Change PRE-EOS	% Change PRE-EOS
CIU/CSU studies (n = 21)
	Iemoli et al. [42]	2010
	Vestergaard & Deleuran [43]	2010	35 ± 0	0 ± 0	−35	100.0%					16.5 ± 12	0 ± 0	−16.5	100.0%
	Wieczorek et al [44].	2011
	Armengot-Carbo et al. [45]	2013
	Song et al. [46]	2013
	Kai et al. [47]	2014									22.8 ± 3.6	4.3 ± 6.1	−18.5	81.1%
	Romano et al. [48]	2015	38.2 ± 5.7	11.7 ± 18.6	−26.5	69.4%
	Tontini et al. [49]	2015	34.6 ± 5	1.4 ± 2.6	−33.2	96.0%
	Clark et al. [50]	2016
	Denman et al. [51]	2016
	Gimenez-Arnau et al. [52]	2016	29.1 ± 7.7	1.4 ± 2.9	−27.7	95.2%									72.7 ± 18.9	12.8 ± 10.3	−59.9	82.4%
	Gomez-Vera et al. [53]	2016	32.1 ± 3.9	2.7 ± 0.6	−29.4	91.6%	6.1 ± 1.2	13.3 ± 0.6	7.2	118.0%
	Gönül et al. [54]	2016
	Konstantinou et al. [54]	2016	27.3 ± 2.5	16 ± 0	−11.3	41.4%	5.7 ± 0.6	12	6.3	110.5%
	Moreira et al. [56]	2016
	Subramaniyan & Chopra [57]	2016	30 ± 7.1	6.5 ± 1.9	−23.5	78.3%					22.3 ± 2.1	6 ± 1.6	−16.3	73.1%
	Ertas et al. [58]	2017
	Gericke et al. [59]	2017
	Kocaturk et al. [60]	2017					6.5 ± 2.9	13.5 ± 3.1	7	107.7%
	Kulthanan et al. [61]	2016	22.9 ± 12.9	3.1 ± 6.4	−19.8	86.5%
	Larrea-Baca et al. [62]	2017	24.1 ± 5.6	5.3 ± 3.5	−18.8	78.0%									52 ± 15.5	32.2 ± 11.2	−19.8	38.1%
CAU studies (n = 3)
	Kaplan et al. [21]	2008									14 ± 6	6 ± 10	−8	57.1%
	Maspero et al. [22]	2009
	Al-Ahmad [63]	2010
CU studies (n = 6)
	Korkmaz et al. [64]	2010
	Ferrer et al. [65]	2011
	Košnik et al. [66]	2014
	Har et al.^a [67]	2015
	Irani et al. [68]	2015
	Seth & Khan [69]	2017
CI/CSU or CU with combordities studies (n = 51)
	Dreyfus & Randolph [70]	2006
	Spector & Tan [18]	2007
	Dreyfus [19]	2008
	Godse [20]	2008
	Magerl et al. [71]	2010	27.8 ± 8.6	4.3 ± 8.9	−23.5	84.5%
	Godse [72]	2011
	Groffik et al. [73]	2011
	Saavedra & Sur [74]	2011
	Sanchez-Machin et al. [75]	2011
	Nam et al. [76]	2012
	Diez et al. [77]	2013
	Labrador-Horrillo et al. [78]	2013
	Lefevre et al. [79]	2013	31.1 ± 2.3	8 ± 3.5	−23.1	74.3%					13.4 ± 1.75	3.8 ± 1.3	−9.6	71.6%
	Viswanathan et al. [80]	2013
	Fiorino et al. [81]	2014	39 ± 1.4	0 ± 0	−39	100.0%
	Metz et al. J Derm Sci. [82]	2014
	Rottem et al. [83]	2014
	Uysal et al. [84]	2014
	Van Den Elzen et al. [85]	2014
	Vieira Dos Santos et al. [86]	2014
	Ghazanfar & Thomsen [87]	2015
	Klossowski et al. [88]	2015
	Leiva-Salinas et al. [89]	2015
	Lundberg et al. [90]	2015
	Netchiporouk et al. [91]	2015	28 ± 0	0 ± 0	−28	100.0%
	Savic et al. [92]	2015	27.5 ± 10.4	3.1 ± 6.3	−24.4	88.7%					19.5 ± 5.2	3.2 ± 5.2	−16.3	83.6%
	Silva et al. [93]	2015
	Sussman et al. [94]	2015
	Wieder et al. [95]	2015
	Bongiorno et al. [96]	2016	31.1 ± 7	2.3 ± 3.2	−28.8	92.6%
	Cuervo-Pardo et al. [97]	2016
	Dawicka et al. [98]	2016	37.5 ± 4.9	8.8 ± 4.3	−28.7	76.5%
	Ensina et al. [99]	2016
	Ertaş et al. [100]	2016
	Ghazanfar et al. [101]	2016
	Gozdzik-Spychalska et al. [102]	2016
	Kasperska-Zajac et al. [103]	2016
	Olszowiec-Chlebna et al. [104]	2016
	Osmenda et al. [105]	2016
	Palacios et al. [106]	2016
	Shahzad [107]	2016	30 ± 0	4 ± 0	−26	86.7%									67 ± 0	30 ± 0	−37	55.2%
	Wilches et al. [108]	2016
	Asero et al. [109]	2017
	Chicharro et al. [110]	2017	37 ± 0	1 ± 0	−36	97.3%
	Deza et al. [111]	2017
	Gonzalez-Medina et al. [112]	2017	42 ± 0	0 ± 0	−42	100.0%
	Iemoli et al. [113]	2017	42 ± 0	14 ± 0	−28	66.7%									49 ± 0	0 ± 0	−49	100.0%
	Marin-Cabanas et al. [114]	2017
	Pinto Gouveia et al. [115]	2017	36.3 ± 5.4	5.1 ± 5.3	−31.2	86.0%
	Porcaro et al. [116]	2017	20 ± 0	6 ± 0	−14	70.0%
	Türk et al.^b [117]	2017
Mixed studies (n = 3)
	Buyukozturk et al. [118]	2012	34.4 ± 6.8	2.9 ± 1.5	−31.5	91.6%									57.5 ± 13.8	10.3 ± 10.4	−47.2	82.1%
	Metz et al. JAMA Derm. [119]	2014
	Sussman et al. [120]	2014	28.3	4	−24.3	85.9%

CAU: chronic auto-immune urticaria; CIU/CSU: chronic idiopathic/spontaneous urticaria; CU-Q2oL: Chronic Urticaria and Quality of Life Questionnaire; CU: chronic urticaria; DLQI: Dermatology Life Quality Index; EOS: end-of-study; PRE: pre-omalizumab; SD: standard deviation; UAS: Urticaria Activity Score; UAS7: Urticaria Activity Score 7; UCT: Urticaria Control Test.

^aFrom 2005 to 2015, 17 patients with refractory CU were placed on a trial of omalizumab. Ten patients (58.8%) responded and 7 (41.2%) did not. This report is on the 10 responders who were treated ≥1 year.

^bOf 18 responders (complete or partial) who subsequently discontinued omalizumab after at least 6 months of treatment, 11 (61.1%) relapsed and 7 (38.9%) sustained remission. Of the 11 who relapsed, 10 were re-treated with omalizumab; all responded to re-treatment, 50% completely, 50% partially.

Table 5. Treatment response rates and clinical outcomes, across all studies and stratified by urticaria subtype.

All studies (n = 84)
	Responder vs. nonresponder				Degree of response
Treatment response	Studies	Patients	Responder	Nonresponder	Studies	Patients	Complete	Partial	None/refractory
Initial response	5	81	83.9%	16.1%	14	186	56.5%	26.9%	16.6%
Final response	13	255	85.0%	15.0%	50	921	67.9%	21.6%	10.5%
		Pretreatment	End-of-study^a
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS	10	245	5.6 ± 0.8	1.0 ± 1.6	−4.6	82.4%	64.3%	100.0%
UAS7	24	275	29.8 ± 7.4	3.8 ± 5.2	−26.0	86.9%	41.4%	100.0%
UCT	3	39	6.2 ± 2.0	13.3 ± 2.0	7.1	113.5%	107.7%	118.0%
DLQI	6	70	17.7 ± 4.8	4.0 ± 5.8	−13.7	76.2%	57.1%	100.0%
CU-Q2oL	5	72	64.1 ± 17.2	17.2 ± 10.6	−46.9	71.1%	38.1%	100.0%
CIU/CSU studies (n = 21)
	Responder vs. nonresponder				Degree of response
Treatment response	Studies	Patients	Responder	Nonresponder	Studies	Patients	Complete	Partial	None/refractory
Initial response	3	57	78.9%	21.1%	3	43	53.5%	27.9%	18.6%
Final response	4	121	88.2%	11.8%	7	184	61.3%	23.1%	15.6%
		Pretreatment	End-of-study
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS	1	25	6.0 ± 0.4	1.0 ± 1.0	−5.0	83.3%
UAS7	9	112	29.2 ± 7.2	3.6 ± 5.2	−25.6	87.5%	41.4%	100.0%
UCT	3	39	6.2 ± 2.0	13.3 ± 2.0	7.1	113.5%	107.7%	118.0%
DLQI	3	12	21.6 ± 5.0	4.2 ± 4.6	−17.4	81.6%	73.1%	100.0%
CU-Q2oL	2	56	66.1 ± 17.9	19.0 ± 10.6	−47.0	68.1%	38.1%	82.4%
CAU studies (n = 3)
					Degree of response
Treatment response					Studies	Patients	Complete	Partial	None/refractory
Initial response					1	1	-	100.0%	-
Final response					3	16	68.7%	25.0%	6.3%
		Pretreatment	End-of-study
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS	2	15	7.1 ± 1.6	2.0 ± 3.1	−4.9	69.9%	64.5%	91.5%
DLQI	1	12	14.0 ± 6.0	6.0 ± 10.0	−8.0	57.1%	-	-
CU studies (n = 6)
	Responder vs. nonresponder				Degree of response
Treatment response	Studies	Patients	Responder	Nonresponder	Studies	Patients	Complete	Partial	None/refractory
Initial response	1	10	100.0%	0.0%	1	1	-	100.0%	-
Final response					6	61	65.3%	24.0%	10.7%
		Pretreatment	End-of-study
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS	1	9	6.0 ± 0.7	0.0 ± 1.5	−6.0	100.0%	-	-
CIU/CSU or CU with comorbidities or conditions studies (n = 51)
	Responder vs. nonresponder				Degree of response
Treatment response	Studies	Patients	Responder	Nonresponder	Studies	Patients	Complete	Partial	None/refractory
Initial response	1	14	92.9%	7.1%	8	79	49.4%	24.0%	26.6%
Final response	9	134	82.1%	17.9%	32	573	69.0%	21.3%	9.7%
		Pretreatment	End-of-study
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS	7	221	5.4 ± 0.7	1.0 ± 1.5	−4.5	82.5%	64.3%	100.0%
UAS7	13	87	31.1 ± 7.7	4.3 ± 5.5	−26.8	86.2%	66.7%	100.0%
DLQI	2	46	17.6 ± 4.5	3.4 ± 4.4	−14.2	79.9%	71.6%	83.6%
CU-Q2oL	2	2	58.0 ± 12.7	15.0 ± 21.2	−43.0	77.6%	55.2%	100.0%
Mixed studies (n = 3)
					Degree of response
Treatment response					Studies	Patients	Complete	Partial	None/refractory
Initial response					1	62	69.4%	27.4%	3.2%
Final response					2	87	75.8%	18.4%	5.8%
		Pretreatment	End-of-study
Clinical outcomes	Studies	Patients	Mean ± SD	Mean ± SD	Change	Mean % change	Range of % change
UAS7	2	76	29.4 ± 6.8	3.8 ± 1.5	−25.6	86.9%	85.9%	91.6%
CU-Q2oL	1	14	57.5 ± 13.8	10.3 ± 10.4	−47.2	82.1%	-	-

^aAs defined in study. Study end ranged from 2 to 70 months.

CU-Q2oL: Chronic Urticaria and Quality of Life Questionnaire; DLQI: Dermatology Life Quality Index; SD: standard deviation; UAS: Urticaria Activity Score; UAS7: Urticaria Activity Score 7; UCT: Urticaria Control Test.

Iemoli E, Piconi S, Fusi A, et al. Immunological effects of omalizumab in chronic urticaria: a case report. J Investig Allergol Clin Immunol. 2010;20(3):252–254.

 PubMed Web of Science ®Google Scholar

Vestergaard C, Deleuran M. Two cases of severe refractory chronic idiopathic urticaria treated with omalizumab. Acta Derm Venereol. 2010;90(4):443–444.

 PubMed Web of Science ®Google Scholar

Wieczorek D, Kapp A, Wedi B. Omalizumab treatment of different urticaria subtypes. Allergo J. 2011;20(5):244–248.

 Google Scholar

Armengot-Carbo M, Velasco-Pastor M, Rodrigo-Nicolas B, et al. Omalizumab in chronic urticaria: a retrospective series of 15 cases. Dermatol Ther. 2013;26(3):257–259.

 PubMed Web of Science ®Google Scholar

Song CH, Stern S, Giruparajah M, et al. Long-term efficacy of fixed-dose omalizumab for patients with severe chronic spontaneous urticaria. Ann Allergy Asthma Immunol. 2013;110(2):113–117.

 PubMed Web of Science ®Google Scholar

Kai AC, Flohr C, Grattan CE. Improvement in quality of life impairment followed by relapse with 6-monthly periodic administration of omalizumab for severe treatment-refractory chronic urticaria and urticarial vasculitis. Clin Exp Dermatol. 2014;39(5):651–652.

 PubMed Web of Science ®Google Scholar

Romano C, Sellitto A, De Fanis U, et al. Omalizumab for difficult-to-treat dermatological conditions: clinical and immunological features from a retrospective real-life experience. Clin Drug Investig. 2015;35(3):159–168.

 PubMed Web of Science ®Google Scholar

Tontini C, Marinangeli L, Cognigni M, et al. Omalizumab in chronic spontaneous urticaria: patient-tailored tapering or planned discontinuation? Ann Allergy Asthma Immunol. 2015;115(2):147–148.

 PubMed Web of Science ®Google Scholar

Clark JJ, Secrest AM, Hull CM, et al. The effect of omalizumab dosing and frequency in chronic idiopathic urticaria: retrospective chart review. J Am Acad Dermatol. 2016;74(6):1274–1276.

 PubMed Web of Science ®Google Scholar

Denman S, Ford K, Toolan J, et al. Home self-administration of omalizumab for chronic spontaneous urticaria. Br J Dermatol. 2016;175(6):1405–1407.

 PubMed Web of Science ®Google Scholar

Giménez-Arnau A, Velasco M, Hita JC, et al. Omalizumab: what benefits should we expect? Eur J Dermatol. 2016;26(4):340–344.

 PubMed Web of Science ®Google Scholar

Gómez-Vera J, Gutiérrez-Ávila SA, Acosta-Gutiérrez DN, et al. Omalizumab in the treatment of antihistamine-resistant chronic urticaria in adults. Ann Allergy Asthma Immunol. 2016;117(2):204–206.

 PubMed Web of Science ®Google Scholar

Gönül M, Özenergün Bittacı A, Ergin C. Omalizumab-induced triphasic anaphylaxis in a patient with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2016;30(11):e135–e136.

 PubMed Web of Science ®Google Scholar

Konstantinou GN, Chioti AG, Daniilidis M. Self-reported hair loss in patients with chronic spontaneous urticaria treated with omalizumab: an under-reported, transient side effect? Eur Ann Allergy Clin Immunol. 2016;48(5):205–207.

 PubMed Web of Science ®Google Scholar

Moreira AC, Lopes MR, Silva SE. Use of omalizumab in the treatment of chronic urticaria. Eur Ann Allergy Clin Immunol. 2016;48(6):242–246.

 PubMed Web of Science ®Google Scholar

Subramaniyan R, Chopra A. Treatment of chronic spontaneous urticaria with a single dose of omalizumab: a study of four cases. Indian J Dermatol. 2016;61(4):467.

 PubMed Web of Science ®Google Scholar

Ertas R, Ozyurt K, Ozlu E, et al. Increased IgE levels are linked to faster relapse in patients with omalizumab-discontinued chronic spontaneous urticaria. J Allergy Clin Immunol. 2017;140(6):1749–1751.

 PubMed Web of Science ®Google Scholar

Gericke J, Metz M, Ohanyan T, et al. Serum autoreactivity predicts time to response to omalizumab therapy in chronic spontaneous urticaria. J Allergy Clin Immunol. 2017;139(3):1059–1061.

 PubMed Web of Science ®Google Scholar

Kocatürk E, Can PK, Akbas PE, et al. Management of chronic inducible urticaria according to the guidelines: a prospective controlled study. J Dermatol Sci. 2017;87(1):60–69.

 PubMed Web of Science ®Google Scholar

Kulthanan K, Tuchinda P, Chularojanamontri L, et al. Omalizumab therapy for treatment of recalcitrant chronic spontaneous urticaria in an Asian population. J Dermatol Treat. 2017;28(2):160–165.

 PubMed Web of Science ®Google Scholar

Larrea-Baca I, Gurpegui-Resano M. Improvement in the quality of life of patients with chronic spontaneous urticaria treated with omalizumab in real life. Enferm Clin. 2017;27(6):361–368.

 PubMed Web of Science ®Google Scholar

Kaplan AP, Joseph K, Maykut RJ, et al. Treatment of chronic autoimmune urticaria with omalizumab. J Allergy Clin Immunol. 2008;122(3):569–573.

 PubMed Web of Science ®Google Scholar

Máspero JF, Parisi CA, De Gennaro M, et al. Chronic autoimmune urticaria: treatment with omalizumab. Archivos Argentinos De Pediatria. 2009;107(5):452–456.

 PubMed Web of Science ®Google Scholar

Al-Ahmad M. Omalizumab therapy in three patients with chronic autoimmune urticaria. Ann Saudi Med. 2010;30(6):478.

 PubMed Web of Science ®Google Scholar

Korkmaz H, Eigelshoven S, Homey B. Omalizumab for therapy-resistant chronic urticaria with angioedema. Hautarzt. 2010;61(10):828–831.

 PubMed Web of Science ®Google Scholar

Ferrer M, Gamboa P, Sanz ML, et al. Omalizumab is effective in nonautoimmune urticaria. J Allergy Clin Immunol. 2011;127(5):1300–1302.

 PubMed Web of Science ®Google Scholar

Košnik M, Kopač P, Eržen R, et al. Omalizumab in chronic urticaria: our experience and literature review. Acta Dermatovenerol Alp Panonnica Adriat. 2014;23(3):57–61.

 PubMedGoogle Scholar

Har D, Patel S, Khan DA. Outcomes of using omalizumab for more than 1 year in refractory chronic urticaria. Ann Allergy Asthma Immunol. 2015;115(2):126–129.

 PubMed Web of Science ®Google Scholar

Irani C, Nahas O. Real-life experience of clinical efficacy of omalizumab use in the Middle East: should we also be concerned about parasites? Clin Antiinflamm Antiallergy Drugs. 2015;2(1):43–46.

 Google Scholar

Seth S, Khan DA. The comparative safety of multiple alternative agents in refractory chronic urticaria patients. J Allergy Clin Immunol Pract. 2017;5(1):165–170.

 PubMed Web of Science ®Google Scholar

Dreyfus DH, Randolph CC. Characterization of an anaphylactoid reaction to omalizumab. Ann Allergy Asthma Immunol. 2006;96(4):624–627.

 PubMed Web of Science ®Google Scholar

Spector SL, Tan RA. Effect of omalizumab on patients with chronic urticaria. Ann Allergy Asthma Immunol. 2007;99(2):190–193.

 PubMed Web of Science ®Google Scholar

Dreyfus DH. Observations on the mechanism of omalizumab as a steroid-sparing agent in autoimmune or chronic idiopathic urticaria and angioedema. Ann Allergy Asthma Immunol. 2008;100(6):624–625.

 PubMed Web of Science ®Google Scholar

Godse KV. Omalizumab in severe chronic urticaria. Indian J Dermatol Venereol Leprol. 2008;74(2):157.

 PubMed Web of Science ®Google Scholar

Magerl M, Staubach P, Altrichter S, et al. Effective treatment of therapy-resistant chronic spontaneous urticaria with omalizumab. J Allergy Clin Immunol. 2010;126(3):665–666.

 PubMed Web of Science ®Google Scholar

Godse KV. Omalizumab in treatment-resistant chronic spontaneous urticaria. Indian J Dermatol. 2011;56(4):444.

 PubMedGoogle Scholar

Groffik A, Mitzel-Kaoukhov H, Magerl M, et al. Omalizumab–an effective and safe treatment of therapy-resistant chronic spontaneous urticaria. Allergy. 2011;66(2):303–305.

 PubMed Web of Science ®Google Scholar

Saavedra MC, Sur S. Down regulation of the high-affinity IgE receptor associated with successful treatment of chronic idiopathic urticaria with omalizumab. Clin Mol Allergy. 2011;9(1):2.

 PubMedGoogle Scholar

Sánchez-Machín I, Iglesias-Souto J, Franco A, et al. T cell activity in successful treatment of chronic urticaria with omalizumab. Clin Mol Allergy. 2011;9(1):11.

 PubMedGoogle Scholar

Nam YH, Kim JH, Jin HJ, et al. Effects of omalizumab treatment in patients with refractory chronic urticaria. Allergy Asthma Immunol Res. 2012;4(6):357–361.

 PubMed Web of Science ®Google Scholar

Díez LS, Tamayo LM, Cardona R. Omalizumab: therapeutic option in chronic spontaneous urticaria difficult to control with associated vasculitis, report of three cases. Biomedica. 2013;33(4):503–512.

 PubMed Web of Science ®Google Scholar

Labrador-Horrillo M, Valero A, Velasco M, et al. Efficacy of omalizumab in chronic spontaneous urticaria refractory to conventional therapy: analysis of 110 patients in real-life practice. Expert Opin Biol Ther. 2013;13(9):1225–1228.

 PubMed Web of Science ®Google Scholar

Lefévre AC, Deleuran M, Vestergaard C. A long term case series study of the effect of omalizumab on chronic spontaneous urticaria. Ann Dermatol. 2013;25(2):242–245.

 PubMed Web of Science ®Google Scholar

Viswanathan RK, Moss MH, Mathur SK. Retrospective analysis of the efficacy of omalizumab in chronic refractory urticaria. Allergy Asthma Proc. 2013;34(5):446–452.

 PubMed Web of Science ®Google Scholar

Fiorino I, Loconte F, Rucco AS, et al. Long-term treatment of refractory severe chronic urticaria by omalizumab: analysis of two cases. Postȩpy Dermatol Alergol. 2014;31(5):332.

 PubMed Web of Science ®Google Scholar

Metz M, Ohanyan T, Church MK, et al. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: a retrospective clinical analysis. J Dermatol Sci. 2014;73(1):57–62.

 PubMed Web of Science ®Google Scholar

Rottem M, Segal R, Kivity S, et al. Omalizumab therapy for chronic spontaneous urticaria: the Israeli experience. Isr Med Assoc J. 2014;16(8):487–490.

 PubMed Web of Science ®Google Scholar

Uysal P, Eller E, Mortz CG, et al. An algorithm for treating chronic urticaria with omalizumab: dose interval should be individualized. J Allergy Clin Immunol. 2014;133(3):914–915.

 PubMed Web of Science ®Google Scholar

Van Den Elzen MT, Rockmann H, Sanders CJG, et al. Treatment of chronic urticaria with omalizumab. Ned Tijdschr Dermatol Venereol. 2014;24(5):253–256.

 Google Scholar

Vieira Dos Santos R, Locks Bidese B, Rabello de Souza J, et al. Effects of omalizumab in a patient with three types of chronic urticaria. Br J Dermatol. 2014;170(2):469–471.

 PubMed Web of Science ®Google Scholar

Ghazanfar MN, Thomsen SF. Successful and safe treatment of chronic spontaneous urticaria with omalizumab in a woman during two consecutive pregnancies. Case Rep Med. 2015;2015:368053.

 PubMedGoogle Scholar

Klossowski N, Braun SA, Von Gruben V, et al. Acquired angioedema with C1-INH deficiency and accompanying chronic spontaneous urticaria in a patient with chronic lymphatic B cell leukemia. Hautarzt. 2015;66(10):723–725.

 PubMed Web of Science ®Google Scholar

Leiva-Salinas M, Francés L, Marin-Cabanas I, et al. Effectiveness and safety of omalizumab in a patient with chronic urticaria and hepatitis C. J Eur Acad Dermatol Venereol. 2015;29(5):1027–1028.

 PubMed Web of Science ®Google Scholar

Lundberg C, Martinez B, Banks TA. Expanding the spectrum: chronic urticaria and autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Ann Allergy Asthma Immunol. 2015;114(4):353–354.

 PubMed Web of Science ®Google Scholar

Netchiporouk E, Nguyen CH, Thuraisingham T, et al. Management of pediatric chronic spontaneous and physical urticaria patients with omalizumab: case series. Pediatr Allergy Immunol. 2015;26(6):585–588.

 PubMed Web of Science ®Google Scholar

Savic S, Marsland A, McKay D, et al. Retrospective case note review of chronic spontaneous urticaria outcomes and adverse effects in patients treated with omalizumab or ciclosporin in UK secondary care. Allergy Asthma Clin Immunol. 2015;11(21):1–11.

 PubMedGoogle Scholar

Silva PM, Costa AC, Mendes A, et al. Long-term efficacy of omalizumab in seven patients with treatment-resistant chronic spontaneous urticaria. Allergol Immunopathol (Madr). 2015;43(2):168–173.

 PubMed Web of Science ®Google Scholar

Sussman G, Gonçalo M, Sánchez-Borges M. Treatment dilemmas in chronic urticaria. J Eur Acad Dermatol Venereol. 2015;29(S3):33–37.

 PubMedGoogle Scholar

Wieder S, Maurer M, Lebwohl M. Treatment of severely recalcitrant chronic spontaneous urticaria: a discussion of relevant issues. Am J Clin Dermatol. 2015;16(1):19–26.

 PubMed Web of Science ®Google Scholar

Bongiorno MR, Crimi N, Corrao S, et al. Omalizumab for the treatment of chronic spontaneous urticaria in clinical practice. Ann Allergy Asthma Immunol. 2016;117(6):703–707.

 PubMed Web of Science ®Google Scholar

Cuervo-Pardo L, Barcena-Blanch M, Radojicic C. Omalizumab use during pregnancy for CIU: a tertiary care experience. Eur Ann Allergy Clin Immunol. 2016;48(4):145–146.

 PubMed Web of Science ®Google Scholar

Dawicka J, Wilkowska A, Grubska-Suchanek E, et al. Omalizumab in the treatment of chronic spontaneous urticaria–literature review and own experience. Przegl Dermatol. 2016;103(1):64–70.

 Web of Science ®Google Scholar

Ensina LF, Valle SO, Juliani AP, et al. Omalizumab in chronic spontaneous urticaria: a Brazilian real-life experience. Int Arch Allergy Immunol. 2016;169(2):121–124.

 PubMed Web of Science ®Google Scholar

Ertaş R, Özyurt K, Yıldız S, et al. Adverse reaction to omalizumab in patients with chronic urticaria: flare up or ineffectiveness? Iran J Allergy Asthma Immunol. 2016;15(1):82–86.

 PubMed Web of Science ®Google Scholar

Ghazanfar MN, Sand C, Thomsen SF. Effectiveness and safety of omalizumab in chronic spontaneous or inducible urticaria: evaluation of 154 patients. Br J Dermatology. 2016;175(2):404–406.

 PubMed Web of Science ®Google Scholar

Gozdzik-Spychalska J, Rzymkowska M, Batura-Gabryel H. Chronic urticaria in a patient with severe atopic asthma-double benefit from treatment with omalizumab. Pol J Allergol. 2016;3:S28–S30.

 Google Scholar

Kasperska-Zajac A, Jarząb J, Żerdzińska A, et al. Effective treatment of different phenotypes of chronic urticaria with omalizumab: case reports and review of literature. Int J Immunopathol Pharmacol. 2016;29(2):320–328.

 PubMed Web of Science ®Google Scholar

Olszowiec-Chlebna M, Sztafińska A, Stelmach I. Teenager suffered from idiopathic anaphylaxis and chronic spontaneous urticaria successfully treated with omalizumab: a case report. Pediatr Allergy Immunol Pulmonol. 2016;29(1):53–55.

 Web of Science ®Google Scholar

Osmenda G, Jasiewicz-Honkisz B. Severe asthma-biological treatment with omalizumab-case report. Pol J Allergol. 2016;3:S26–S27.

 Google Scholar

Palacios T, Stillman L, Borish L, et al. Lack of basophil CD203c-upregulating activity as an immunological marker to predict response to treatment with omalizumab in patients with symptomatic chronic urticaria. J Allergy Clin Immunol Pract. 2016;4(3):529.

 PubMed Web of Science ®Google Scholar

Shahzad H. A case of refractory chronic spontaneous urticaria treated with omalizumab. J Pakistan Assoc Dermatol. 2016;26(3):276–278.

 Google Scholar

Wilches P, Wilches P, Calderon JC, et al. Omalizumab for chronic urticaria in Latin America. World Allergy Organ J. 2016;9(1):36.

 PubMedGoogle Scholar

Asero R, Marzano AV, Ferrucci S, et al. D-dimer plasma levels parallel the clinical response to omalizumab in patients with severe chronic spontaneous urticaria. Int Arch Allergy Immunol. 2017;172(1):40–44.

 PubMed Web of Science ®Google Scholar

Chicharro P, Rodríguez-Jiménez P, De Argila D. Efficacy and safety of omalizumab in a patient with chronic spontaneous urticaria and active hepatitis B virus infection. Actas Dermosifiliogr (English Edition). 2017;108(4):383–384.

 PubMedGoogle Scholar

Deza G, Bertolín-Colilla M, Pujol RM, et al. Basophil FcεRI expression in chronic spontaneous urticaria: a potential immunological predictor of response to omalizumab therapy. Acta Derm Venereol. 2017;97(6):698–704.

 PubMed Web of Science ®Google Scholar

González-Medina M, Curto-Barredo L, Labrador-Horrillo M, et al. Omalizumab use during pregnancy for chronic spontaneous urticaria (CSU): report of two cases. J Eur Acad Dermatol Venereol. 2017;31(5):e245–e246.

 PubMed Web of Science ®Google Scholar

Iemoli E, Niero F, Borgonovo L, et al. Successful omalizumab treatment in HIV positive patient with chronic spontaneous urticaria: a case report. Eur Ann Allergy Clin Immunol. 2017;49(2):88.

 PubMed Web of Science ®Google Scholar

Marín-Cabañas I, Berbegal-De Gracia L, De León-Marrero F, et al. Management of chronic spontaneous urticaria in routine clinical practice following the EAACI/GA (2) LEN/EDF/WAO guidelines. Actas Dermosifiliogr (English Edition). 2017;108(4):346–353.

 PubMedGoogle Scholar

Pinto Gouveia M, Gameiro A, Pinho A, et al. Long-term management of chronic spontaneous urticaria with omalizumab. Clin Exp Dermatol. 2017;42(7):735–742.

 PubMed Web of Science ®Google Scholar

Porcaro F, Di Marco A, Cutrera R. Omalizumab in patient with aspirin exacerbated respiratory disease and chronic idiopathic urticaria. Pediatr Pulmonol. 2017;52(5):e26–e28.

 PubMed Web of Science ®Google Scholar

Türk M, Yılmaz I, Bahçecioğlu SN. Treatment and retreatment with omalizumab in chronic spontaneous urticaria: real life experience with twenty-five patients. Allergol Int. 2018;67(1):85–89. First identified in search as e-pub ahead of print : 2017 May 26. DOI:10.1016/j.alit.2017.05.003

 PubMed Web of Science ®Google Scholar

Büyüköztürk S, Gelincik A, Demirtürk M, et al. Omalizumab markedly improves urticaria activity scores and quality of life scores in chronic spontaneous urticaria patients: a real life survey. J Dermatol. 2012;39(5):439–442.

 PubMed Web of Science ®Google Scholar

Metz M, Ohanyan T, Church MK, et al. Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria. JAMA Dermatol. 2014;150(3):288–290.

 PubMed Web of Science ®Google Scholar

Sussman G, Hébert J, Barron C, et al. Real-life experiences with omalizumab for the treatment of chronic urticaria. Ann Allergy Asthma Immunol. 2014;112(2):170–174.

 PubMed Web of Science ®Google Scholar