Recurrent Chronic Idiopathic Urticaria Post-hysterectomy and Loss of Xolair Effectiveness: A Case Report

We present the case of a 44-year-old woman with a history of chronic idiopathic urticaria (CIU) who initially achieved remission with omalizumab (Xolair) but experienced a relapse following a hysterectomy. Despite reinitiating treatment, her symptoms persisted, requiring escalating doses of antihistamines and systemic corticosteroids. This case highlights the potential role of hormonal shifts and surgical stress in triggering urticaria recurrence and contributing to biologic treatment failure, though causality remains unproven due to the lack of objective hormonal or immunologic data. It underscores the importance of closely monitoring treatment response over time and exploring alternative therapeutic strategies when standard approaches prove inadequate. Further research is needed to elucidate the mechanisms underlying post-surgical urticaria exacerbations and optimize long-term management for affected patients.