Patients who develop itchy wheals in response to cold or friction benefit from treatment with omalizumab, a drug normally used to treat asthma. Two separate clinical studies, conducted by researchers from Charité - Universitätsmedizin Berlin, have shown the drug's active substance to be highly effective against different types of urticaria (hives). Results from these studies have been published in the current edition of the Journal of Allergy and Clinical Immunology.
Cold urticaria and symptomatic dermographism are different forms of inducible urticaria, a skin disease characterized by itchy wheals, which develop in response to physical stimuli such as cold or friction. Patients with cold urticaria, for instance, cannot go swimming in the sea without risking an allergic reaction that may lead to shock; similarly, they cannot hold items colder than room temperature. In patients with symptomatic dermographism, even gentle friction, such as that caused by clothing or physical contact, can result in severe itching. People affected by the disorder often experience a reduced quality of life, and are forced to make adjustments to both their social and working lives.
As part of two investigator-initiated, multicenter, randomized, placebo-controlled trials, researchers from the Department of Dermatology, Venereology and Allergology used the monoclonal antibody omalizumab to treat two different patient groups (61 patients with symptomatic dermographism and 31 patients with cold urticaria) for a period of three months. In order to test the efficacy of treatment, researchers used objective measurement techniques to determine provocation threshold values for all study participants. Initial measurements were carried out prior to the first administration of the drug. Once the second dose had been administered, measurements were repeated at four-weekly intervals, followed by a final measurement two weeks after the final dose. Results showed that treatment with omalizumab led to significant improvements in symptoms in both groups of patients, and prevented symptoms in nearly half of all patients with cold urticaria and symptomatic dermographism, even after exposure to the relevant stimuli.
"Our results show that patients with severe forms of physical urticaria can benefit from treatment with omalizumab," says Prof. Dr. Martin Metz. The drug is currently only licensed for use in patients with traditional hives, known as chronic spontaneous urticaria. "However, given our data on the drug's effectiveness in patients with cold urticaria and symptomatic dermographism, we are hopeful that the drug will be made available to both of these patient groups," adds Prof. Metz.
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Martin Metz et al, Omalizumab is Effective in Cold Urticaria - Results of a Randomized, Placebo Controlled Trial, Journal of Allergy and Clinical Immunology (2017). DOI: 10.1016/j.jaci.2017.01.043