Updosed Omalizumab in Chronic Spontaneous Urticaria With or Without Symptomatic Dermographism

BACKGROUND: One-third of patients with chronic spontaneous urticaria (CSU) require treatment beyond the licensed dose of omalizumab, but real-world data on response and predictors of updosed omalizumab remain limited. OBJECTIVES: We evaluated response rates to updosed omalizumab in CSU patients with or without symptomatic dermographism (SD) and explored predictors of response to 450 mg every 4 weeks. METHODS: We retrospectively analyzed 57 patients (27 CSU, 30 CSU + SD) who were poorly responsive to or lost response at licensed-dose omalizumab (300 mg every 4 weeks). All received omalizumab 450 mg every 4 weeks for at least 3 months; selected patients were further escalated to 600 mg. Disease control was assessed using the Urticaria Control Test (UCT), with scores ≥12 indicating well-controlled disease. Baseline clinical and laboratory characteristics were compared between responders and nonresponders. RESULTS: Overall, 71.9% of 57 patients achieved disease control with omalizumab 450 mg over 6 months. Among patients who remained poorly controlled, 10 were escalated to 600 mg, of whom 9 (90%) achieved disease control. Baseline UCT scores were higher in responders than nonresponders (9 vs. 7.5, p = 0.015). No significant differences were observed for age, BMI, total IgE, anti-TPO levels, or concomitant SD. Low baseline IgE did not preclude response to updosed treatment. CONCLUSIONS: Omalizumab updosing to 450 mg or 600 mg every 4 weeks appears effective in CSU patients with inadequate response to licensed dosing. Higher baseline UCT scores may predict better response, whereas conventional poor-response biomarkers seem less informative in updosed regimens.