Omalizumab for the treatment of solar urticaria

Published online: March 20, 2018

Solar urticaria is a rare inducible (physical) urticaria caused by exposure to light. Some patients have to completely avoid outdoor activities, which has a severe impact on their quality of life. Treatment of solar urticaria may be challenging. Omalizumab, a recombinant humanized anti IgE antibody, was approved as a treatment for antihistamine refractory chronic spontaneous urticaria; however, data regarding its efficacy in solar urticaria is scarce.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, Snast and colleagues evaluated the efficacy and safety of omalizumab in the treatment of solar urticaria. They described a series of 5 patients with solar urticaria not responsive to high dose oral antihistamines and leukotriene receptor antagonists, who received treatment with omalizumab. Additionally, they conducted a comprehensive (systematic) literature review of studies that described treatment of solar urticaria with omalizumab and recorded the clinical benefits and adverse events during treatment.

The case series consisted of 5 patients including 2 children, 6 and 10 years old. Monthly omalizumab injections resulted in clinical improvement in all patients and complete remission in 4. No patient experienced adverse effects. The literature review included 48 patients that failed treatment with antihistamines. Patients received monthly omalizumab treatment over a follow-up period of 4 to 200 weeks. Some patients required higher than standard doses of omalizumab. About 80% of patients experienced clinical improvement and half remained free of symptoms. Four patients (11%) had mild adverse effects and no patient had severe adverse events.

The authors concluded that symptoms of antihistamine refractory solar urticaria can be safely and effectively controlled by treatment with omalizumab in most patients. Some patients may require higher than standard doses to achieve disease control.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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