In individuals with well-controlled urticaria under omalizumab therapy, the second-generation antihistamines are effective agents to treat the intermittent symptoms of chronic spontaneous urticaria (CSU). 

A study was conducted to explore the effectiveness of as-needed second-generation antihistamines in patients having well-controlled urticaria under omalizumab therapy.

A total of 53 participants were enrolled in this study (38 females, mean age 41.1 ± 11.4 years). The study includes CSU patients who were given omalizumab therapy (300 mg/4 weeks for at least three months). These patients had well-controlled urticaria and were using second-generation antihistamines only if required.

Utilizing the modified urticaria activity score-twice daily, the efficacy of second-generation antihistamines, alteration in the hives, itch, and total itch-hives scores prior to and after antihistamines were assessed.    

The intake of second-generation antihistamines minimized itch, hives, and total itch-hives scores, as  shown below: 

As noted, the decline in the symptoms was comparable in both the isolated-urticaria and urticaria and angioedema phenotypes. The baseline levels of IgE were positively linked with the decline of the symptom scores. It indicated that in people having a higher baseline total IgE levels, administration of as-needed second-generation antihistamines lowered the symptom scores less. 

In CSU patients with well-controlled urticaria under omalizumab therapy, the second-generation antihistamines effectively decrease symptoms such as itch and hives. The baseline total IgE levels may be utilized as a potential biomarker for the effectiveness of these agents in urticaria patients.