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To the Editor, Standard treatments for chronic spontaneous urticaria (CSU) including the second-generation H1-antihistamines (SGAH) are often ineffective even with four times the FDA-recommended dose. 1,2 Eosinophilic infiltrates and an abundance of interleukin-5 (IL5) in CSU lesions (hives) support a role for IL5 in the pathomechanism(s) of CSU. 3 Thus, the use of biologic therapies, for example, benralizumab targeting IL5-receptor-α, in treating SGAH-resistant CSU was hypothesized.A repeated-measures, 24-week study was designed and conducted at an urticaria clinic to determine clinical efficacy of benralizumab in CSU. Twelve SGAH-unresponsive CSU patients (3 males, 9 females; 2 blacks, 10 whites; between ages 32-65 years) having a median daily Urticaria Activity Score (UAS7) 4 of 4 and pruritus severity ≥2 were enrolled. After a baseline run-in period, subjects were treated with a subcutaneous placebo dose followed by benralizumab 30 mg subcutaneously every month (×3 doses) followed by two off-medication monthly visits. Subject-reported responses to UAS7 and CU-QoL questionnaires were recorded at the monthly visits. The primary and exploratory endpoints were the change in UAS7 and Chronic Urticaria Quality-of-Life Total Score (CUQoLTS) respectively, from 4 weeks after placebo dose (visit 2) to 4 weeks after last dose of benralizumab (visit 5). Nine subjects completed

Purpose of reviewThe current review describes the incidence and risk for anaphylaxis due to allergy injections. Recent findingsThe incidence of fatal anaphylaxis occurs with approximately one in 7.2 million injection visits. Severe anaphylaxis may occur once in every 160 000 visits. The major risk for fatal anaphylaxis is severe and uncontrolled asthma.