Omalizumab is a safe, efficacious, and rapid intervention for people with delayed pressure urticaria (DPU) refractory to two or more 2nd generation H1-antihistamines in an up-dosing regimen, according to the outcomes of a recent study published in International Archives of Allergy and Immunology.

In this real-world ambispective observational study, the researchers aimed to assess the safety and efficacy of omalizumab in 14 patients with DPU (64.28% women) without chronic spontaneous urticaria or other forms of chronic inducible urticaria and to outline their diagnostic and clinical properties. The intervention was started with 300 mg omalizumab every four weeks. 

Recording of Urticaria Control Test (UCT) scores prior to and post first dose, antithyroid peroxidase (anti-TPO) antibodies, total IgE, D dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), diagnostic testing, prior intervention, diagnosis time, and age was done. As per the UCT score, the effectiveness of omalizumab was estimated. The side effects and satisfactory response following the first dose (superfast) were assessed.

The diagnosis time was noted to be 4.53 (±5.54) years. Following the removal of the stimulus, 4.18 h (±2.75) was the meantime threshold. After testing, 32.42 (±13.8) hrs was the mean duration of lesions. Notably, 50% of patients displayed high ESR values (>20.0 mm/h). In 42.85% CRP was >0.5 mg/dL and in 3/10 patients, D dimer levels were high (>500.0 ng/mL).

As found, 100% of patients exhibited normal anti-TPO levels. In 6/8 patients, total IgE was found to be >100 IU/mL. Before treatment with omalizumab, the medium UCT levels were 3.07 (±2.40). Following the first dose of omalizumab, the medium UCT levels came out to be 15.28/16 (±1.72). No side effects were reported. All 14 participants responded rapidly.

Hence, the monoclonal antibody omalizumab is recommended for people suffering from delayed pressure urticaria who do not respond to up-dosing antihistamines and/or cyclosporine, montelukast, or corticosteroids.