Commentary: Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria

Chronic urticaria affects approximately 0·1% of the population. The disease is not life threatening, but it is very disabling and has a significant effect on quality of life.1 Approximately 50% of patients are unresponsive to H1‐antihistamines,2 and commonly used second‐line agents such as ciclosporin or prednisolone have marked adverse effects. Thus there is a need for a safe and effective second‐line therapy. Omalizumab, a recombinant humanized monoclonal anti‐IgE antibody that is effective in asthma and has a very good safety record,3 appears to fulfil this need. The main drawback at present is its cost. In this multicentre, phase 3 study, Maurer et al.4 gave three different doses of omalizumab to 323 patients with chronic spontaneous urticaria (CSU) resistant to treatment with antihistamines. Short‐term use of omalizumab produced a significant reduction in urticaria scores, particularly at the highest dose of 300 mg monthly, with little in the way of adverse events.