Biologics in Chronic Urticaria - 20/12/17

Doi : 10.1016/j.iac.2016.08.004

Adeeb Bulkhi, MD ^a,^b, Andrew J. Cooke, MD ^a, Thomas B. Casale, MD ^a,^⁎
^a Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, FL, USA
^b Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

^∗Corresponding author. 12901 Bruce B. Downs Boulevard, MDC 19, Tampa, FL 33612.12901 Bruce B. Downs BoulevardMDC 19TampaFL33612

Résumé

Chronic urticaria (CU) is defined as wheals, angioedema, or both, that last more than 6 weeks. Second-generation antihistamines are considered the first-line therapy for CU. Unfortunately, many patients will fail antihistamines and require alternative therapy, including immune response modifiers or biologics. Multiple biological agents have been evaluated for use in antihistamine-refractory CU, including omalizumab, rituximab, and intravenous immunoglobulin; omalizumab is the most efficacious. Because of the success of omalizumab, multiple new biologics that are directed at the IgE pathway are under investigation. This review summarizes the relevant data regarding the efficacy of biologics in antihistamine-refractory CU.

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Keywords : Chronic urticaria, Biologics, Omalizumab, Therapy, Rituximab, TNF antagonist, Intravenous immunoglobulin therapy

Plan

Key points

Anti–immunoglobulin E monoclonal antibodies

Overview and Mechanism of Action of Omalizumab

Omalizumab Proof-of-Concept and Phase 2 Studies

Omalizumab Phase 3 Trials

Omalizumab and Urticaria Guidelines

Effectiveness of Omalizumab in Other Forms of Urticaria

Omalizumab in Pregnancy

Advances in Anti–immunoglobulin E Monoclonal Antibodies

Anti-CD20 monoclonal antibody

Intravenous immunoglobulin

Tumor necrosis factor-α antagonists

Interleukin-1 antagonists

Summary

	Conflicts of Interest: Dr A. Bulkhi and Dr A.J. Cooke have no conflicts of interest to disclose. Dr T.B. Casale has been an investigator on grants from Novartis and Genentech to his University and has been on advisory boards for Novartis and Genentech with all funds to his University employer.
	Funding: No sources of funding were used to support the writing of this article.