Dermographism is the most common form of physical urticaria with a prevalence of up to 5%. Dermographism is characterized by itchy wheals that occur in response to friction, i.e. after rubbing or scratching of the skin and it usually lasts 1 to 2 hours. Dermographism usually lasts for years and it impacts quality of life. The underlying cause is unknown and the triggers are usually impossible to avoid. Treatment with antihistamines (claritin, zyrtec, allegra, xyzal) are the first choice of treatment. Standard daily dosing is usually not sufficient to suppress the rashes in dermographism and higher conventional dosing is often times needed. However some patients do not respond to higher dosing for dermographism.
Xolair (omalizumab) is a humanized anti-IgE antibody effective for patients with anti-histamine refractory patients with chronic idiopathic urticaria.
There have been case reports of patients with dermographism who have failed elevated antihistamine dosing who have benefitted from Xolair. A recent study published in the September 2017 issue of the Journal of Allergy and Clinical Immunology titled “Omalizumab is effective in symptomatic dermographism-results of a randomized placebo-controlled trial”, looked into the treat of Xolair for dermographism.
Treatment with 150mg or 300mg of Xolair (omalizumab) had improved quality of life and clinically meaningful reductions of disease activity. There was no statistical difference between the 2 dosages, whereas in chronic hives the 300mg dose is more effective.
It is unclear why Xolair has strong effects in disease activity in dermographism. As of now, no relevant role in IgE in dermographism has been proven. There are current case reports showing Xolair can help in other forms of physical urticaria such as cold, pressure and solar.
If you suffer from dermographism that is not controlled with conventional antihistamines, see a board certified allergy doctor who can discuss all possible treatment options best for you.