TOPLINE:

A majority of adolescents with chronic spontaneous urticaria (CSU) had relapse after discontinuing omalizumab treatment; early onset of the disease and a longer duration of symptoms before omalizumab treatment were associated with an increased risk for relapse.

METHODOLOGY:

• Researchers conducted a retrospective study to assess the relapse rate after discontinuation of omalizumab in adolescents with antihistamine-resistant CSU.
• The study involved 59 patients (median age, 14 years; 50.8% boys) who achieved complete remission after receiving at least one cycle of omalizumab and discontinued the treatment.
• The median number of treatment cycles was nine, with a median cumulative dose of 2700 mg. The median follow-up duration was 54 months.
• Disease activity was assessed using the sum of daily Urticaria Activity Scores over 7 days and according to European Academy of Allergy and Clinical Immunology guidelines.

TAKEAWAY:

• Overall, 47.5% of patients experienced relapse after treatment discontinuation, with 75.6% experiencing recurrence of CSU in the first year of follow-up. The relapse rates at 12 and 24 months were 37.3% and 46.8%, respectively.
• Patients who did vs did not experience relapse were younger at onset of CSU (median age, 11.9 vs 14.1 years; P = .028) and had a longer median duration of symptoms before initiating omalizumab (21 vs 8 months; P = .010).
• A clear link was observed between CSU relapse and how long symptoms lasted before initiating omalizumab; waiting more than 7.5 months raised the risk for relapse (area under the curve, 0.695; sensitivity, 82.1%; specificity, 45.2%; P = .010).
• Clinical or laboratory markers were not significantly different between patients with and without relapse.

IN PRACTICE:

“These results suggest that when CSU patients do not respond adequately to quadruple antihistamine treatment, omalizumab therapy should be initiated at the appropriate time without extending the follow-up period,” the authors wrote. 

SOURCE:

Ümit Murat Şahiner, with the Hacettepe University Faculty of Medicine in Ankara, Türkiye, was the corresponding author of the study, which was published online on October 2, 2025 in Pediatric Allergy and Immunology.

LIMITATIONS: 

Because the study was retrospective, some clinical and laboratory data were unavailable. As a single-center referral study, the patient population consisted largely of more severe cases. The relatively small sample size and uneven distribution between groups may have limited statistical power and generalizability.

DISCLOSURES:

The study did not receive any funding. The authors reported having no conflicts of interest related to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.