Omalizumab is effective and safe for the management of urticaria in adults and pediatrics refractory to a variety of treatments such as high-dose H1-antihistamines.

In order to investigate the effectiveness of various Omalizumab doses for responder rates, urticarial assessment score 7 (UAS7), weekly wheal scores, and weekly itching scores, a meta-analysis was conducted.

A systematic search of Web of Science, Embase, Scopus, and MEDLINE/PubMed was carried out in accordance with the PRISMA Statement 2020 guidelines. The following keywords were used in combination: chronic urticaria and Omalizumab. Information on the mean age, female gender, clinical trial ID, name, author/year, country, dose and period of intervention, inclusion criteria, and racial grouping was gathered. The meta-analytical results were examined in RevMan 5.4. Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to conduct the risk-of-bias evaluation.

In total, 10 trials along with 1705 CSU patients were incorporated. Notably, 543 volunteers were in the control group (65.6% females) and 1162 volunteers were in the intervention group (70.4% females). As found, 38.64 ± 10.66 years was the overall mean age. The 150 mg dose (Cohen's d = -2.6) resulted in the most noticeable weekly itch score results.

With the dose of 300 mg (Cohen's d = -1.45), the weekly wheal score results exhibited the biggest effect size. The 150 mg dose (Cohen's d = -6.92) resulted in the highest effect size for UAS7 outcomes. With 300 mg of the intervention compared to the placebo, the Omalizumab response rate was greater (Odds Ratio = 8.65). With Omalizumab doses of 150 mg and 300 mg, well-rounded urticarial symptom relief was seen. While the likelihood of a therapeutic response was greater with a 300 mg dose, improvement of UAS7 was similar to 150 mg.

Both 300 mg and 150 mg doses of IgE targeted biologic Omalizumab showed excellent urticarial symptom resolution. With 150 mg doses, improvement in UAS7 scores was more significant. With 300 mg doses, the odds of complete resolution of symptoms were greater.