Omalizumab

In addition to anti-H1 antihistamines, omalizumab is more effective than placebo in adult patients with CSU who have an inadequate response to anti-H1 antihistamines at variable doses.

The recommended (MA) dose of omalizumab is 300 mg/4 weeks.

There are no data in the literature enabling us to determine the interval between the failure of anti-H1 antihistamines and the initiation of omalizumab.

This interval varies between 1 and 6 months, depending on experts.

There are no long-term follow-up data on their efficacy.

The most common adverse reactions reported in trials were:

• respiratory infections,
• headaches,
• and diarrhoea.

Regarding tolerance, there are no long-term data on CSU, but data on higher doses are available from asthma patients.

Cyclosporine

Cyclosporine is the immunosuppressant most widely used after failure of anti-H1 drugs. The dose of cyclosporine is 4 or 5 mg/kg/day initially, followed by a gradual decrease in 15-day increments, according to the literature. The maximum study period was 6 months. Cyclosporine was prescribed in addition to conventional or double-dose anti-H1 antihistamines.

The most common adverse effects reported in trials were:

• headaches,
• digestive problems,
• paraesthesia,
• high blood pressure,
• hypertrichosis.

The WG does not recommend the use of other immunosuppressants in CSU due to lack of studies with a sufficient level of evidence, or due to negative studies (methotrexate).