Abstract
Chronic urticaria (CU) defined as repeatedly occurred itchy wheals and/or angioedema for at least 6 weeks. Due to the unpredictability, recurrent and disabling symptoms, and a considerably impaired quality of life, effective and tolerable treatment for CU patients is crucial. Almost a half of patients with CU are refractory to H1-antihistamines, even though the dose of antihistamines is increased up to 4-fold. Recently treatment modulating IgE levels and activities provides an efficient therapeutic approach. Omalizumab, the only approved anti-IgE treatment for chronic spontaneous urticaria (CSU) patients until now, with a strong evidence of the efficacy and safety, opened a new horizon in the care of the patients whose urticaria is not controlled with antihistamines. Recent international guidelines recommend omalizumab as the first choice of treatment for antihistamine-refractory CSU. However, as it is not curative neither disease-modifying agent, there is a subpopulation of CSU patients responding partly or never to omalizumab. The other things to be solved in the treatment of CU is that clinical evidence is still limited on chronic inducible urticaria (CIndU) and special populations. Thus, a new anti-IgE treatment, ligelizumab is actively evaluated in the efficacy compared with both placebo and omalizumab. Further understandings on the pathogenesis of CU can lead to the development of new mechanism-based therapeutics for CU patients.
Highlights
Symptomatic management to relieve itchy wheals has been recognized as the standard of care for chronic urticaria
These results indicate that omalizumab is effective in controlling symptoms, but they do not provide evidence that omalizumab induces remission from chronic spontaneous urticaria (CSU)
In a phase 2b multicenter randomized placebo controlled trial, patients with antihistamine-refractory CSU were randomized to placebo, 300 mg of omalizumab, or 24, 72, or 240 mg of ligelizumab administered by subcutaneous injection with 4-week interval for 20 weeks [55]
Summary
Symptomatic management to relieve itchy wheals has been recognized as the standard of care for chronic urticaria. Around a half of patients with CU are refractory to recommended doses neither an increased doses of antihistamine. Management guidelines for CU in past included omalizumab, cyclosporine, dapsone, hydroxychloroquine, methotrexate, montelukast, colchine, and phototherapy as alternative treatment for antihistamine-refractory CU [1, 2]. Omalizumab is the only biologics, approved for management of chronic spontaneous urticaria (CSU) in patients at age 12 years or older by Food and Drug Administration (FDA). It a recombinant humanized IgG1, monoclonal anti-IgE antibody. Omalizumab binds to free IgE at the Fc region and prohibits IgE from interacting with high-affinity receptor for Fc region of IgE (FcɛRI) on mast cells, basophils and eosinophils [5, 6]. This chapter reviews the current evidence of the efficacy, safety, and treatment response to biologics targeting IgE, including omalizumab, ligelizumab and quilizumab in CU patients
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