Chronic inducible urticaria (
CIndU) is a subgroup of
chronic urticaria which can cause severe quality of life impairment by their refractory forms. The recommended treatment approach in
CindU is the same as that for
chronic spontaneous urticaria (CSU). However,
CIndU seem to be more resistant to standard doses of H1
antihistamines (AHs) and higher doses of AHs are required for symptom control.
Omalizumab, a recombinant
anti-IgE antibody, effectively treats CSU. Nevertheless, there is not enough evidence in patients with
CIndU, especially in AHs resistant cases. This study analyzed 2 severe cases of
CIndU (
cold urticaria and
symptomatic dermographism) with completely different response to
omalizumab. We describe 2 patients with 2 subtypes of
CIndU: one with severe
cold urticaria (including
anaphylaxis) and the other with severe extensive symptomatic dermographysm. In both cases, we performed complete positive and differential diagnostic work-up. Management strategies included first line and second line symptomatic
therapy, but with no success in either case. Avoidance of eliciting triggers was difficult to achieve (occupational reasons). We decided to start
omalizumab treatment, 300 mg every 4 weeks for 6 months. The
cold urticaria patient gained complete symptom relief 10 days after the first dose of
omalizumab; the quality of life improved substantially with no side effects of the treatment. The
urticaria factitia patient showed no benefit of the add-on 5 months treatment with
omalizumab. He refused the 6th dose of
omalizumab due to the lack of response, and also
cyclosporine, but he showed some benefits of oral
corticosteroids. Although many clinical studies support the use of
omalizumab in the treatment of patients with
CIndU, we certainly need more data for prediction of a good clinical response.