Omalizumab for the Treatment of Solar Urticaria: Case Series and Systematic Review of the Literature

Snast, Igor; Kremer, Noa; Lapidoth, Moshe; Enk, Claes D.; Tal, Yuval; Rosman, Yossi; Confino‐Cohen, Ronit; Hodak, Emmilia; Levi, Assi

doi:10.1016/j.jaip.2018.02.032

Cited by 38 publications

(24 citation statements)

References 36 publications

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“…The patients whose disease failed to improve under treatment with antihistamines and an LRA were given omalizumab in incremental doses, to a dose above the standard (> 300 mg) when necessary. In a recent systematic review by members of our group, 38 (79%) of 48 patients with antihistamine‐refractory SU achieved clinical improvement with omalizumab . Similarly, symptoms were completely alleviated, with no AEs, in five (83%) of the six omalizumab‐treated patients in our cohort, including two who received a dose that was higher than standard (> 300 mg).…”

Section: Discussionmentioning

confidence: 60%

Real‐life experience in the treatment of solar urticaria: retrospective cohort study

et al. 2019

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Background. Solar urticaria (SU) is a rare photodermatosis causing a significant impact on patients' quality of life (QoL), and treatment is often challenging. Aim. To analyse clinical experience with a tailored stepwise therapeutic approach. Methods. A retrospective cohort design was used. Patients with suspected SU underwent laboratory investigations and photoprovocation. Those with a high minimal urticaria dose (MUD) were treated with a single antihistamine (protocol 1), and those with a lower MUD received three types of antihistamines (protocol 2); both protocols included a leucotriene receptor antagonist (LRA). In cases of failure, treatment was switched to omalizumab at doses of < 300 mg/month with incremental dosage increases as necessary (monthly dose range, 150-600 mg/month). Symptom relief and photoprovocation under treatment were evaluated. Results. In total, 30 patients (10 men, 20 women) were enrolled. Most (87%) were sensitive to visible light (1-70 J/cm 2 ) with or without extension to ultraviolet A. Of the 30 patients, 23 opted for our stepwise approach: 22 achieved complete remission on protocols 1 or 2 (n = 17) or after switching to omalizumab (n = 5), and another patient achieved partial remission under omalizumab. There were no treatmentrelated severe adverse effects. Conclusions. Symptoms of SU can be well controlled by treatment with antihistamines and an LRA tailored to the degree of photosensitivity, followed by omalizumab in refractory cases. This has important implications for patient QoL.

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Section: Discussionmentioning

confidence: 60%

Real‐life experience in the treatment of solar urticaria: retrospective cohort study

et al. 2019

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“…The satisfactory response to omalizumab in our patient, after the failure of previous standard therapeutic strategies, confirms the effectiveness of this molecule in the treatment of solar urticaria which, despite what reported in several studies, has not yet been recognized and authorized by the competent Health Authorities in the treatment of this condition. Recently Snast et al [4] reported that omalizumab provides clinical benefits in approximately 80% of patients with solar urticarial and that those who fail to respond on standard doses may improve with higher monthly dosages. Based on our studies, and what is reported in recent scientific publications, omalizumab could be an effective and safe therapeutic alternative in the treatment of solar urticaria.…”

Section: Discussionmentioning

confidence: 99%

“…A total or partial failure of standard therapies is observed in a subset of patients that necessitate a different pharmacological approach. In recent years, omalizumab, a recombinant DNA-derived humanized anti IgE monoclonal antibody approved for severe-moderate asthma and chronic idiopathic urticaria, seems to be safe and effective also in the treatment of solar urticaria [4].…”

Section: Introductionmentioning

confidence: 99%

Solar urticaria, a disease with many dark sides: is omalizumab the right therapeutic response? Reflections from a clinical case report

2019

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AbstractSolar urticaria is a rare type of photodermatosis that significantly reduces the quality of life of the subjects affected, with a risk of anaphylaxis should the entire body be exposed to the sun. Patients are forced to modify and limit their normal activities, and since the symptoms are triggered by exposure to sun, which is difficult if not impossible to avoid in everyday life, a safe and effective therapy appears to be essential.Unfortunately, traditional therapies in a discrete number of patients are unable to provide adequate and safe answers.We describe the case of an 18-year-old woman who began to manifest the first symptoms walking under the spring sunshine. A few minutes after sun exposure, itching and burning sensation began, followed immediately by erythema appearance in the photoexposed skin areas.She was treated with non-sedating H1-blocking antihistamines and leukotriene antagonist with no success, so we decided to treat with omalizumab.The satisfactory response after the failure of previous standard therapeutic strategies, confirms the effectiveness of this molecule in the treatment of solar urticaria, which despite what reported in several studies, has not yet been recognized and authorized by the competent Health Authorities in the treatment of this condition.

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“…proposed that hardening with phototherapy is due to the persistent binding of photoallergens to IgE binding sites after irradiation, thus preventing histamine release. Recently, omalizumab, a humanized anti‐IgE antibody, has been successfully used in many cases of SU …”

Section: Discussionmentioning

confidence: 99%

Successful treatment of solar urticaria with UVA1 hardening in three patients

Lyons

Peacock

Zubair

et al. 2019

Photoderm Photoimm Photomed

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Solar urticaria (SU) is an uncommon photodermatosis that presents with sensitivity to ultraviolet (UV) or visible light which triggers urticarial lesions. Treatment of SU is a challenge and usually involves antihistamines and photoprotection as a first-line treatment. Phototherapy regimens are recommended if these first-line treatments fail to control the disease. Induction of tolerance by phototherapy (UV hardening) has been commonly described as a treatment modality. UVA1 has deeper penetration to the dermis than UVA or NB-UVB; its use in SU has not been previously reported.We present 3 patients with SU who were successfully treated with UVA1.

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Omalizumab for the Treatment of Solar Urticaria: Case Series and Systematic Review of the Literature

Cited by 38 publications

References 36 publications

Real‐life experience in the treatment of solar urticaria: retrospective cohort study

Real‐life experience in the treatment of solar urticaria: retrospective cohort study

Solar urticaria, a disease with many dark sides: is omalizumab the right therapeutic response? Reflections from a clinical case report

Successful treatment of solar urticaria with UVA1 hardening in three patients

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