Effect of age on omalizumab response in chronic urticaria: a retrospective comparison between adult and geriatric populations
Main Article Content
Keywords
age, chronic spontaneous urticaria, geriatric, omalizumab, treatment response
Abstract
Background: Chronic urticaria (CU) can occur at any age, but comorbidities, age-related immune changes, and polypharmacy may influence treatment outcomes in older adults. Limited data exist on the effect of age on omalizumab efficacy. This study aimed to evaluate the impact of age on treatment response, safety, and clinical–laboratory features in adult (aged <65 years) and geriatric (aged ≥65 years) CU patients receiving omalizumab.
Methods: This retrospective study included 153 CU patients who initiated omalizumab between 2019 and 2024 because of resistance to antihistamines. Patients were categorized by age (<65 or ≥65 years) and by Urticaria Control Test (UCT) scores at the 4th month (responders: UCT ≥12; non-responders: UCT <12). Demographic, clinical, and laboratory parameters were compared between groups.
Results: The median age was 44 years (interquartile range: 35–54), and 63.4% were females. Of all the patients, 130 (85.0%) were aged <65 years and 23 (15.0%) were aged ≥65 years. The overall response rate was 83.7%, with no significant difference between age groups (P = 0.965). Geriatric patients had more comorbidities (P < 0.001), polypharmacy (P = 0.004), and malignancy (P = 0.045). Basophil (P = 0.013) and eosinophil (P = 0.024) counts were lower in the elderly. Among non-responders, autoimmune disease (P = 0.004), elevated anti-thyroglobulin (P = 0.016), and lower baseline UCT scores (P = 0.009) were more frequent. No serious adverse events occurred.
Conclusions: Omalizumab is effective and safe for CU even in older adults. Age, comorbidities, and polypharmacy do not affect treatment response, while autoimmunity and baseline disease activity may predict outcomes.
References
1 Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–414. 10.1111/all.13397
2 Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015;45(3):547–65. 10.1111/cea.12494
3 Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 Update. J Allergy Clin Immunol. 2014;133(5):1270–7. 10.1016/j.jaci.2014.02.036
4 Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66(3):317–30. 10.1111/j.1398-9995.2010.02496.x
5 Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, et al. Diagnosis and treatment of urticaria and angioedema: A worldwide perspective. World Allergy Organ J. 2012;5(11):125–47. 10.1097/WOX.0b013e3182758d6c
6 Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: Prevalence and clinical course. J Dermatol. 2007;34(5):294–301. 10.1111/j.1346-8138.2007.00276.x
7 Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol. 2013;132(1):101–9. 10.1016/j.jaci.2013.05.013
8 Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, et al. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol. 2022;149(6):1819–31. 10.1016/j.jaci.2022.04.010
9 Lang DM, Sheikh J, Joshi S, Bernstein JA. Endotypes, phenotypes, and biomarkers in chronic spontaneous urticaria: Evolving toward personalized medicine. Ann Allergy Asthma Immunol. 2025;134(4):408–17.e3. 10.1016/j.anai.2024.10.026
10 Batyrbayeva A, Ispayeva Z, Pashimov M, Kaibullayeva J, Baidildayeva M, Kapalbekova U, et al. Clinical phenotypes and biomarkers in chronic urticaria. Clin Chim Acta. 2025;571:120233. 10.1016/j.cca.2025.120233
11 Makris M, Maurer M, Zuberbier T. Pharmacotherapy of chronic spontaneous urticaria. Expert Opin Pharmacother. 2013; 14(18):2511–9. 10.1517/14656566.2013.850490
12 Kaplan AP, Giménez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy. 2017;72(4):519–33. 10.1111/all.13083
13 Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: A randomized, placebo-controlled study. J Invest Dermatol. 2015;135(1):67–75. 10.1038/jid.2014.306
14 Gimenez-Arnau AM, Salman A, Podder I. Biomarkers to predict therapeutic response in chronic spontaneous urticaria: A review. Eur J Dermatol. 2024;34(1):3–12. 10.1684/ejd.2024.4600
15 Nettis E, Cegolon L, Di Leo E, Canonica WG, Detoraki A. Omalizumab in elderly patients with chronic spontaneous urticaria: An Italian real-life experience. Ann Allergy Asthma Immunol. 2018;120(3):318–23. 10.1016/j.anai.2017.12.007
16 Di Bona D, Nettis E, Bilancia M, Ridolo E, Minenna E, Nizi MC, et al. Duration of chronic spontaneous urticaria remission after omalizumab discontinuation: A long-term observational study. J Allergy Clin Immunol Pract. 2021;9(6):2482–5.e2. 10.1016/j.jaip.2021.02.044
17 Kitao R, Oda Y, Washio K, Tai Y, Ono R, Nishigori C, et al. Lower efficacy of omalizumab in older adults with chronic spontaneous urticaria. J Dermatol. 2022;49(7):729–31. 10.1111/1346-8138.16370
18 Longhurst HJ, Gonçalo M, Godse K, Ensina LF. Managing chronic urticaria and recurrent angioedema differently with advancing age. J Allergy Clin Immunol Pract. 2021;9(6):2186–94. 10.1016/j.jaip.2021.03.034
19 Curto-Barredo L, Pujol RM, Roura-Vives G, Gimenez-Arnau AM. Chronic urticaria phenotypes: Cinical differences regarding triggers, activity, prognosis and therapeutic response. Eur J Dermatol. 2019;29(6):627–35. 10.1684/ejd.2019.3674
20 Magen E, Chikovani T, Waitman DA, Kahan NR. Factors related to omalizumab resistance in chronic spontaneous urticaria. Allergy Asthma Proc. 2019;40(4):273–8. 10.2500/aap.2019.40.4230
21 Martina E, Damiani G, Grieco T, Foti C, Pigatto PDM, Offidani A. It is never too late to treat chronic spontaneous urticaria with omalizumab: Real-life data from a multicenter observational study focusing on elderly patients. Dermatol Ther. 2021;34(2):e14841. 10.1111/dth.14841
22 Shah AD, Denaxas S, Nicholas O, Hingorani AD, Hemingway H. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: A CALIBER cohort study. Open Heart. 2016;3(2):e000477. 10.1136/openhrt-2016-000477
23 Huang AH, Chichester KL, Saini SS. Association of basophil parameters with disease severity and duration in chronic spontaneous urticaria (CSU). J Allergy Clin Immunol Pract. 2020;8(2):793–5.e6. 10.1016/j.jaip.2019.08.004
24 Kolkhir P, Church MK, Altrichter S, Skov PS, Hawro T, Frischbutter S, et al. Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity, and poor response to treatment. J Allergy Clin Immunol Pract. 2020;8(1):318–25.e5. 10.1016/j.jaip.2019.08.025
25 Oda Y, Fukunaga A, Washio K, Imamura S, Mizuno M, Hatakeyama M, et al. Improved FcεRI-mediated CD203c basophil responsiveness reflects rapid responses to omalizumab in chronic spontaneous urticaria. J Allergy Clin Immunol Pract. 2021;9(3):1166–76.e8. 10.1016/j.jaip.2020.08.048
26 Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy. 2018;73(4):940–8. 10.1111/all.13352
27 Asero R, Tedeschi A, Riboldi P, Griffini S, Bonanni E, Cugno M. Severe chronic urticaria is associated with elevated plasma levels of D-dimer. Allergy. 2008;63(2):176–80. 10.1111/j.1398-9995.2007.01514.x
28 Tedeschi A, Kolkhir P, Asero R, Pogorelov D, Olisova O, Kochergin N, et al. Chronic urticaria and coagulation: Pathophysiological and clinical aspects. Allergy. 2014;69(6):683–91. 10.1111/all.12389
29 Grzanka R, Damasiewicz-Bodzek A, Kasperska-Zajac A. Interplay between acute phase response and coagulation/fibrinolysis in chronic spontaneous urticaria. Allergy Asthma Clin Immunol. 2018;14:27. 10.1186/s13223-018-0255-8
30 Cugno M, Genovese G, Ferrucci S, Casazza G, Asero R, Marzano AV. IgE and D-dimer baseline levels are higher in responders than nonresponders to omalizumab in chronic spontaneous urticaria. Br J Dermatol. 2018;179(3):776–7. 10.1111/bjd.16593
31 Maurer M, Altrichter S, Bieber T, Biedermann T, Bräutigam M, Seyfried S, et al. Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J Allergy Clin Immunol. 2011;128(1):202–9.e5. 10.1016/j.jaci.2011.04.038
32 Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A, et al. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol. 2011;128(3):567–73.e1. 10.1016/j.jaci.2011.06.010
33 Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–35. 10.1056/NEJMoa1215372
34 Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Canvin J, et al. Effect of omalizumab on angioedema in H1 antihistamine-resistant chronic spontaneous urticaria patients: Results from X-ACT, a randomized controlled trial. Allergy. 2016;71(8):1135–44. 10.1111/all.12870
35 Lefévre AC, Deleuran M, Vestergaard C. A long-term case series study of the effect of omalizumab on chronic spontaneous urticaria. Ann Dermatol. 2013;25(2):242–5. 10.5021/ad.2013.25.2.242
36 Sussman G, Hébert J, Barron C, Bian J, Caron-Guay RM, Laflamme S, et al. Real-life experiences with omalizumab for the treatment of chronic urticaria. Ann Allergy Asthma Immunol. 2014;112(2):170–4. 10.1016/j.anai.2013.12.005
37 Metz M, Ohanyan T, Church MK, Maurer M. Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria. JAMA Dermatol. 2014;150(3):288–90. 10.1001/jamadermatol.2013.8705
38 Uysal P, Eller E, Mortz CG, Bindslev-Jensen C. An algorithm for treating chronic urticaria with omalizumab: Dose interval should be individualized. J Allergy Clin Immunol. 2014;133(3):914–5.e2. 10.1016/j.jaci.2013.10.015
39 Ivyanskiy I, Sand C, Thomsen SF. Omalizumab for chronic urticaria: A case series and overview of the literature. Case Rep Dermatol. 2012;4(1):19–26. 10.1159/000336205
40 Asero R, Canonica GW, Cristaudo A, Fierro MT, Girolomoni G, Marzano AV, et al. Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: An Italian perspective. Curr Opin Allergy Clin Immunol. 2017;17(6):453–9. 10.1097/ACI.0000000000000404
41 Ghazanfar MN, Sand C, Thomsen SF. Effectiveness and safety of omalizumab in chronic spontaneous or inducible urticaria: Evaluation of 154 patients. Br J Dermatol. 2016;175(2):404–6. 10.1111/bjd.14540
42 Metz M, Ohanyan T, Church MK, Maurer M. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: A retrospective clinical analysis. J Dermatol Sci. 2014;73(1):57–62. 10.1016/j.jdermsci.2013.08.011
43 Narváez-Fernández EJ, Entrala A, Nin-Valencia A, Mir-Ihara P, Losantos-García I, Domínguez-Ortega J, et al. Long-term omalizumab in elderly patients with chronic urticaria: is it a safe therapy? Int Arch Allergy Immunol. 2023;184(10):1003–9. 10.1159/000530494
2 Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015;45(3):547–65. 10.1111/cea.12494
3 Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 Update. J Allergy Clin Immunol. 2014;133(5):1270–7. 10.1016/j.jaci.2014.02.036
4 Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66(3):317–30. 10.1111/j.1398-9995.2010.02496.x
5 Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, et al. Diagnosis and treatment of urticaria and angioedema: A worldwide perspective. World Allergy Organ J. 2012;5(11):125–47. 10.1097/WOX.0b013e3182758d6c
6 Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: Prevalence and clinical course. J Dermatol. 2007;34(5):294–301. 10.1111/j.1346-8138.2007.00276.x
7 Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol. 2013;132(1):101–9. 10.1016/j.jaci.2013.05.013
8 Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, et al. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol. 2022;149(6):1819–31. 10.1016/j.jaci.2022.04.010
9 Lang DM, Sheikh J, Joshi S, Bernstein JA. Endotypes, phenotypes, and biomarkers in chronic spontaneous urticaria: Evolving toward personalized medicine. Ann Allergy Asthma Immunol. 2025;134(4):408–17.e3. 10.1016/j.anai.2024.10.026
10 Batyrbayeva A, Ispayeva Z, Pashimov M, Kaibullayeva J, Baidildayeva M, Kapalbekova U, et al. Clinical phenotypes and biomarkers in chronic urticaria. Clin Chim Acta. 2025;571:120233. 10.1016/j.cca.2025.120233
11 Makris M, Maurer M, Zuberbier T. Pharmacotherapy of chronic spontaneous urticaria. Expert Opin Pharmacother. 2013; 14(18):2511–9. 10.1517/14656566.2013.850490
12 Kaplan AP, Giménez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy. 2017;72(4):519–33. 10.1111/all.13083
13 Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: A randomized, placebo-controlled study. J Invest Dermatol. 2015;135(1):67–75. 10.1038/jid.2014.306
14 Gimenez-Arnau AM, Salman A, Podder I. Biomarkers to predict therapeutic response in chronic spontaneous urticaria: A review. Eur J Dermatol. 2024;34(1):3–12. 10.1684/ejd.2024.4600
15 Nettis E, Cegolon L, Di Leo E, Canonica WG, Detoraki A. Omalizumab in elderly patients with chronic spontaneous urticaria: An Italian real-life experience. Ann Allergy Asthma Immunol. 2018;120(3):318–23. 10.1016/j.anai.2017.12.007
16 Di Bona D, Nettis E, Bilancia M, Ridolo E, Minenna E, Nizi MC, et al. Duration of chronic spontaneous urticaria remission after omalizumab discontinuation: A long-term observational study. J Allergy Clin Immunol Pract. 2021;9(6):2482–5.e2. 10.1016/j.jaip.2021.02.044
17 Kitao R, Oda Y, Washio K, Tai Y, Ono R, Nishigori C, et al. Lower efficacy of omalizumab in older adults with chronic spontaneous urticaria. J Dermatol. 2022;49(7):729–31. 10.1111/1346-8138.16370
18 Longhurst HJ, Gonçalo M, Godse K, Ensina LF. Managing chronic urticaria and recurrent angioedema differently with advancing age. J Allergy Clin Immunol Pract. 2021;9(6):2186–94. 10.1016/j.jaip.2021.03.034
19 Curto-Barredo L, Pujol RM, Roura-Vives G, Gimenez-Arnau AM. Chronic urticaria phenotypes: Cinical differences regarding triggers, activity, prognosis and therapeutic response. Eur J Dermatol. 2019;29(6):627–35. 10.1684/ejd.2019.3674
20 Magen E, Chikovani T, Waitman DA, Kahan NR. Factors related to omalizumab resistance in chronic spontaneous urticaria. Allergy Asthma Proc. 2019;40(4):273–8. 10.2500/aap.2019.40.4230
21 Martina E, Damiani G, Grieco T, Foti C, Pigatto PDM, Offidani A. It is never too late to treat chronic spontaneous urticaria with omalizumab: Real-life data from a multicenter observational study focusing on elderly patients. Dermatol Ther. 2021;34(2):e14841. 10.1111/dth.14841
22 Shah AD, Denaxas S, Nicholas O, Hingorani AD, Hemingway H. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: A CALIBER cohort study. Open Heart. 2016;3(2):e000477. 10.1136/openhrt-2016-000477
23 Huang AH, Chichester KL, Saini SS. Association of basophil parameters with disease severity and duration in chronic spontaneous urticaria (CSU). J Allergy Clin Immunol Pract. 2020;8(2):793–5.e6. 10.1016/j.jaip.2019.08.004
24 Kolkhir P, Church MK, Altrichter S, Skov PS, Hawro T, Frischbutter S, et al. Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity, and poor response to treatment. J Allergy Clin Immunol Pract. 2020;8(1):318–25.e5. 10.1016/j.jaip.2019.08.025
25 Oda Y, Fukunaga A, Washio K, Imamura S, Mizuno M, Hatakeyama M, et al. Improved FcεRI-mediated CD203c basophil responsiveness reflects rapid responses to omalizumab in chronic spontaneous urticaria. J Allergy Clin Immunol Pract. 2021;9(3):1166–76.e8. 10.1016/j.jaip.2020.08.048
26 Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy. 2018;73(4):940–8. 10.1111/all.13352
27 Asero R, Tedeschi A, Riboldi P, Griffini S, Bonanni E, Cugno M. Severe chronic urticaria is associated with elevated plasma levels of D-dimer. Allergy. 2008;63(2):176–80. 10.1111/j.1398-9995.2007.01514.x
28 Tedeschi A, Kolkhir P, Asero R, Pogorelov D, Olisova O, Kochergin N, et al. Chronic urticaria and coagulation: Pathophysiological and clinical aspects. Allergy. 2014;69(6):683–91. 10.1111/all.12389
29 Grzanka R, Damasiewicz-Bodzek A, Kasperska-Zajac A. Interplay between acute phase response and coagulation/fibrinolysis in chronic spontaneous urticaria. Allergy Asthma Clin Immunol. 2018;14:27. 10.1186/s13223-018-0255-8
30 Cugno M, Genovese G, Ferrucci S, Casazza G, Asero R, Marzano AV. IgE and D-dimer baseline levels are higher in responders than nonresponders to omalizumab in chronic spontaneous urticaria. Br J Dermatol. 2018;179(3):776–7. 10.1111/bjd.16593
31 Maurer M, Altrichter S, Bieber T, Biedermann T, Bräutigam M, Seyfried S, et al. Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J Allergy Clin Immunol. 2011;128(1):202–9.e5. 10.1016/j.jaci.2011.04.038
32 Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A, et al. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol. 2011;128(3):567–73.e1. 10.1016/j.jaci.2011.06.010
33 Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–35. 10.1056/NEJMoa1215372
34 Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Canvin J, et al. Effect of omalizumab on angioedema in H1 antihistamine-resistant chronic spontaneous urticaria patients: Results from X-ACT, a randomized controlled trial. Allergy. 2016;71(8):1135–44. 10.1111/all.12870
35 Lefévre AC, Deleuran M, Vestergaard C. A long-term case series study of the effect of omalizumab on chronic spontaneous urticaria. Ann Dermatol. 2013;25(2):242–5. 10.5021/ad.2013.25.2.242
36 Sussman G, Hébert J, Barron C, Bian J, Caron-Guay RM, Laflamme S, et al. Real-life experiences with omalizumab for the treatment of chronic urticaria. Ann Allergy Asthma Immunol. 2014;112(2):170–4. 10.1016/j.anai.2013.12.005
37 Metz M, Ohanyan T, Church MK, Maurer M. Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria. JAMA Dermatol. 2014;150(3):288–90. 10.1001/jamadermatol.2013.8705
38 Uysal P, Eller E, Mortz CG, Bindslev-Jensen C. An algorithm for treating chronic urticaria with omalizumab: Dose interval should be individualized. J Allergy Clin Immunol. 2014;133(3):914–5.e2. 10.1016/j.jaci.2013.10.015
39 Ivyanskiy I, Sand C, Thomsen SF. Omalizumab for chronic urticaria: A case series and overview of the literature. Case Rep Dermatol. 2012;4(1):19–26. 10.1159/000336205
40 Asero R, Canonica GW, Cristaudo A, Fierro MT, Girolomoni G, Marzano AV, et al. Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: An Italian perspective. Curr Opin Allergy Clin Immunol. 2017;17(6):453–9. 10.1097/ACI.0000000000000404
41 Ghazanfar MN, Sand C, Thomsen SF. Effectiveness and safety of omalizumab in chronic spontaneous or inducible urticaria: Evaluation of 154 patients. Br J Dermatol. 2016;175(2):404–6. 10.1111/bjd.14540
42 Metz M, Ohanyan T, Church MK, Maurer M. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: A retrospective clinical analysis. J Dermatol Sci. 2014;73(1):57–62. 10.1016/j.jdermsci.2013.08.011
43 Narváez-Fernández EJ, Entrala A, Nin-Valencia A, Mir-Ihara P, Losantos-García I, Domínguez-Ortega J, et al. Long-term omalizumab in elderly patients with chronic urticaria: is it a safe therapy? Int Arch Allergy Immunol. 2023;184(10):1003–9. 10.1159/000530494