Relapse after omalizumab discontinuation in chronic spontaneous urticaria

BACKGROUND: Post-cessation relapse is difficult to compare because patient selection, outcome definitions and observation periods vary. OBJECTIVE: To synthesize relapse after omalizumab cessation in CSU and CSU-predominant cohorts and examine interpretive limitations. METHODS: We updated searches in PubMed, Embase, Scopus and Web of Science on 23 October 2026. Source-defined clinical relapse after complete cessation was separated from taper failure and retreatment. Random-effects logit pooling and sensitivity analyses addressed population, response, follow-up, overlapping reports and statistical models. RESULTS: = 87.7%; prediction interval 16.0-79.9%). CSU-only pooling gave 47.1% (95% CI 40.2-54.2%). Results reflect different follow-up periods, not a common time-specific risk. Eighty-three candidate full reports were unavailable. Three newly verified small risk sets contributed 0/1, 0/2 and 3/5 outcomes; excluding sets with fewer than ten stoppers yielded 46.3%. Pure dose reduction was supported by one observational arm. Confirmed type IIb-specific relapse counts were unavailable. CONCLUSION: Relapse is common after cessation, but high heterogeneity limits individualized prediction. The evidence cannot establish a causal advantage of any stopping strategy or an immune endotype for recurrence.