Partielles Ansprechen einer Lichturtikaria auf Omalizumab

Abstract

The treatment of solar urticaria is regarded as difficult. In some cases good responses to the anti-IgE antibody omalizumab (Xolair®), approved for treatment of chronic spontaneous urticaria, have been reported. We report on a 50-year-old Caucasian woman who for the last 5 years has developed localized itching and stinging erythemas following exposure to sunlight accompanied sometimes by anaphylactic reactions. Oral antihistamines in three- to four-fold doses and a topical sun screen had been only partially effective in long-term use. Positive immediate-type reactions with whealing appeared in phototesting with low doses of UVB and UVA. Three weeks after s. c. injection of 300 mg omalizumab, the minimal urticarial dose (MUD) for UVB was increased at least 20-fold (from<0.001 to 0.02 J/cm) and for UVA four-fold (from 0.1 to 0.4 J/cm) and the patient reported no itching at the test area. On the other hand, MUD for UVA1 remained unchanged (5.0 J/cm). The weekly urticarial activity score (UAS7) was reduced from 30 points before omalizumab administration to 14 points in weeks two and three. Overall, a partial response of solar urticaria to omalizumab therapy could be observed in the present case.

Omalizumab treatment in patients with chronic inducible urticaria: A systematic review of published evidence

“…87,89 Of all CIndU subtypes, solar urticaria had the highest number of publications on omalizumab use. Of 18 publications that included 36 cases, the majority showed that omalizumab successfully controlled symptoms, whereas 4 included patients with a partial response, 39,42,57,58 and 3 showed failure to respond to treatment. 40,59,60 The strongest evidence came from a multicenter, prospective, phase II study including 10 antihistamine-refractory patients with solar urticaria that greatly affected their QoL (DLQI score of >10).…”

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

“…Unfortunately, traditional therapies are often unable to provide adequate and safe responses in solar urticaria, leading to a reduce quality of life in individuals affected, who are forced to significantly limit their normal activities [19, 20, 21].…”

“…Despite the effectiveness shown by omalizumab in many cases of solar urticaria refractory to conventional therapies, a certain proportion of subjects remain who do not respond satisfactorily [18, 19, 20, 21], and it is therefore necessary to study more thoroughly the pathogenetic mechanism of the disease in order to be able to select the patients and establish with confidence the most appropriate treatment.…”