LAUSR

The anti-IgE antibody, omalizumab, is an effective treatment for cutaneous symptoms of chronic spontaneous urticaria (CSU) [1]. As some CSU patients exhibit extracutaneous symptoms (CSU+) [2], we studied the evolution of extracutaneous symptoms in CSU+ patients treated with omalizumab. We retrospectively collected data from all CSU+ patients treated with omalizumab and followed in the Department of Clinical Immunology of Grenoble-Alpes University Hospital, France. Since 2014, 137 patients were treated with omalizumab, among whom 19 presented extracutaneous symptoms. Thirteen of them were included in this study. Informed consent from all patients was collected. The median age of our patient cohort was 43 years (range: 17-77). The majority of patients were women (65.2%). The median age at the appearance of the first symptoms was 26 years (range: 6-68) and the age at diagnosis was 38 years (range: 1372). The major debilitating symptoms pretherapy were angioedema (92%), wheals (100%), gastro-intestinal (GI) symptoms (abdominal cramps, diarrhea, nausea) (77%) and fatigue (54%). Other symptoms were postural orthostatic tachycardia syndrome (POTS) (n=6), arthralgias (n=4), wheezing (n=4), headache (n=3), bone pain (n=1), anaphylaxis (n=1) and keratoconjunctivitis (n=1). All patients simultaneously received H1-antihistamines (92%), H2antihistamines (31%) or treatment with anti-leukotrienes (15%). Among them, three (25%) were treated with a median dose of 300 mg/three weeks, eight (69%) received a dose of 300 mg/month and two (17%) a dose of 300 mg/fortnight. The injections were mainly (75%) delivered at home. The median age at first injection was 40 years (range: 14-75). For our collected data, we noticed improvements that appeared one month post-treatment (range: 1-9) (table 1). Patients noticed notable improvement in POTS (100%), GI symptoms (77%), arthralgias (50%), and headache (67%). The patients also noticed improvement in cutaneous CSU symptoms (such as angioedema, wheals and fatigue) (83%). Omalizumab was given during a median period of 18 months (range: 5-51) with no serious adverse events. The commonest side effects included transient asthenia (54%), fainting attack (16%) and arthralgia (8%). One patient (8%) exhibited exacerbation after the first injections. No longterm side effects were observed. CSU is defined as daily pruritic wheals, angioedema, or both, for six weeks or more, without an identifiable trigger. The international EAACI/GA2LEN/EDF/WAO urticaria Table 1. Efficacy and safety of omalizumab in CSU+ patients (n=13).