Predictors of response to omalizumab and relapse in chronic spontaneous urticaria: a study of 470 patients

A. V. Marzano, G. Genovese, G. Casazza, M. T. Fierro, P. Dapavo, N. Crimi, S. Ferrucci, P. Pepe, S. Liberati, P. D. Pigatto, A. Offidani, E. Martina, G. Girolomoni, M. Rovaris, C. Foti, L. Stingeni, A. Cristaudo, G. W. Canonica, E. Nettis, R. Asero

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Background: Chronic spontaneous urticaria (CSU) is defined as spontaneous occurrence of wheals and/or angioedema for ≥6 weeks. Omalizumab is a monoclonal anti-IgE antibody effective in refractory CSU, but its mechanism of action and markers predictive of response remain not completely defined. Objectives: To correlate baseline levels of two proposed biomarkers, total IgE (bIgE) and d-dimer (bd-dimer), and clinical parameters to omalizumab response and to relapses after drug withdrawal. Methods: In this retrospective Italian multicentre study, clinical data were collected in 470 CSU patients, and bIgE and bd-dimer were measured in 340 and 342 patients, respectively. Disease activity was determined by Urticaria Activity Score 7 (UAS7) at week 1 and 12 after omalizumab starting. Relapses were evaluated during a 2- and 3-month interval after a first and a second course of treatment, respectively. Results: bIgE correlated to a good response to omalizumab since levels were significantly higher in responders than non-responders (P = 0.0002). Conversely, bd-dimer did not correlate to response. There was no correlation between both bIgE and d-dimer and either first or second relapse. Disease duration was significantly longer in patients who experienced either first or second relapse (P 
Original languageEnglish
JournalJournal of the European Academy of Dermatology and Venereology
Publication statusPublished - Jan 1 2018


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Marzano, A. V., Genovese, G., Casazza, G., Fierro, M. T., Dapavo, P., Crimi, N., Ferrucci, S., Pepe, P., Liberati, S., Pigatto, P. D., Offidani, A., Martina, E., Girolomoni, G., Rovaris, M., Foti, C., Stingeni, L., Cristaudo, A., Canonica, G. W., Nettis, E., & Asero, R. (2018). Predictors of response to omalizumab and relapse in chronic spontaneous urticaria: a study of 470 patients. Journal of the European Academy of Dermatology and Venereology.