Immune Disorders

Role of Biologics (Omalizumab) in Chronic Urticaria

Written by Dr. Suvash Sahu and medically reviewed by iCliniq medical review team.

 

Omalizumab, an antibody derived from murine blood acts against human immunoglobulin E (IgE). This drug was approved by FDA (Food and Drug Administration) for use in chronic idiopathic urticaria. It can be used in a patient who does not respond to approved doses of H1 antihistamines.

Mechanism of Action:

Basophils and mast cells are store house of various allergy causing mediators. These mediators are released when IgE in the body binds to receptors present over these cells. Omalizumab inhibits this phenomenon of binding IgE to these cells. Omalizumab binds to free IgE in the body fluids with much higher affinity, thus preventing binding of IgE to the receptors present over basophils and mast cells.

Omalizumab does not bind to already receptor bound IgE or to the receptor directly. These binding characteristics allow Omalizumab to neutralize IgE mediated responses without release of allergy causing mediators.

Usage and Dose of Omalizumab:

  1. In chronic idiopathic urticaria, subcutaneous injection of 150 to 300 mg repeated every two to four weeks for 12 weeks.
  2. In case of atopic dermatitis, systemic mastocytosis and bullous urticaria, 150 to 300 mg subcutaneous injection two to four weekly.

Side Effects:

  • Injection site reactions in the form of swelling, redness, pain, bruising, itching, bleeding and urticaria have been reported in 12% of Omalizumab treated patients.
  • Omalizumab associated anaphylaxis are seen in 0.2% of patients. Around two hours of observation period is needed for the first three injections and 30 minutes for subsequent injections.
  • Malignancy - malignant neoplasms were observed in 0.5% of patients treated with Omalizumab as compared to 0.2% in patients not treated with Omalizumab. Some of the observed malignancies include breast, non-melanoma skin, prostate, melanoma and parotid.
  • Other side effects like nausea, sinusitis, upper respiratory tract infections, joint pain, headache, cough, etc., have been reported.
  • In case of pregnancy and lactation, it comes under category B medicine. It means, Omalizumab can be given with caution.

Special Consideration Before Administration:

This drug should be administered by a physician or a healthcare professional, who is trained in recognition and treatment of anaphylaxis. Symptoms of systemic eosinophilia along with clinical features of urticarial vasculitis occurs more often in patients who are on Omalizumab, which usually reduce with oral corticosteroid dosage.

Some patients have experienced some signs and symptoms, including joint pain, skin rashes, fever and enlargement of lymph node in the form of painful pea shaped swelling in the axilla or groin areas. This usually occurs with an onset of one to five days after the first and subsequent injections of Omalizumab. Therapy should be discontinued if such symptoms occur.

For further information about Omalizumab consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Last reviewed at: 07.Sep.2018

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