Chronic spontaneous urticaria involves recurrent episodes of hives with or without swelling for 6 weeks or longer from unknown causes. Although chronic hives tends to be self-limited in most patients, it affects quality of life. Most studies show that it affects 0.5% to 1% of the general population. The trigger is unknown and treatment includes up to 4 times the standard dosing of second-generation antithistamines, H-2 antihistamines and/or leukotriene receptor antagonists.
Current consensus guidelines added Xolair (omalizumab) in 2014 for chronic spontaneous urticaria. Long term use of Xolair for chronic hives has been determined to be efficacious and safe, but there is a question of it if it can be discontinued or tapered. Some studies have shown the hives to return after stopping treatment. Other studies have shown for tapering or discontinuing Xolair. Also there is a question whether someone can discontinue or decrease concomitant medication.
A recent study published in the Annals of Allergy, Asthma and Immunology journal titled “Real-world dosing of omalizumab for chronic spontaneous urticaria”, sought to answer some of the above questions.
Adult patients with chronic spontaneous urticaria, changed their dosing frequency to 6, 8, or 12 weeks (instead of the usual 4 weeks). They were also adjusted from 300mg to 150mg.
The study showed that a significant proportion of patients taking medications were able to decrease or stop them even while the Xolair was tapered. Many patients were able to decrease the 4 week cumulative dose of Xolair and still achieve control with a longer interval.
The results of this study showed that many patients with chronic spontaneous urticaria on Xolair, are able to taper Xolair and other medications that they are using to control their hives.