Omalizumab: a broader role in dermatology? Evidence and the road ahead

Omalizumab is a humanized monoclonal IgG1 antibody approved by the US-FDA for the treatment of chronic spontaneous urticaria (CSU) unresponsive to H1-antihistamines. The aim of this review is to outline the utility of omalizumab in all types of urticarias, as well as other off-label dermatological disorders. A comprehensive literature search was conducted to identify studies evaluating the utility of omalizumab in dermatology. Databases searched included PubMed, Medline, and Embase. All original studies including case reports, case series and clinical trials were included if they were full-text, involved a dermatologic disorder treated with omalizumab and published in English. Articles were excluded if they were conference abstracts, non-clinical reports, or invitro studies. Apart from CSU, the efficacy of omalizumab has been demonstrated in atopic dermatitis (AD), bullous pemphigoid (BP), hyper IgE syndrome (HIES), mastocytosis, and Kimura's disease (KD), with the level of evidence varying for each disorder. Besides, in anecdotal reports, the benefits of omalizumab in TEN and Netherton Syndrome has been highlighted. Omalizumab offers a promising therapeutic option for a variety of dermatologic disorders beyond CSU. Further research is needed to optimize treatment protocols and establish definitive guidelines for omalizumab use in these conditions to facilitate quicker disease remission, improved safety, and reduced reliance on conventional immunosuppressants. However, the high cost of omalizumab remains a significant barrier for its widespread use in developing countries.