A 36-year-old woman had recurrent generalized wheals that occurred without known triggers. She reported that each time her wheals lasted a couple of hours and caused itching. 

She had been diagnosed with chronic spontaneous urticaria (CSU) 4 years back. The patient was treated with cyclosporine, which adequately controlled her symptoms within 10 months.

The patient’s serum total IgE concentration was increased. Her thyroid autoantibodies – serum antithyroid peroxidase antibody (anti-TPO IgG) and antithyroglobulin antibody (anti-TG IgG), were in the normal range. 

However, cyclosporine failed to halt the recent exacerbation; therefore, topical omalizumab 300 mg was prescribed. This therapy controlled her lesions within 3 days, but the wheals recurred after 5 days.

Thereafter, the omalizumab dose was increased to 450 mg for 3 days every month for the next 3 months. This treatment prevented symptom recurrence; the dose was then tapered to 300 mg/month. 

A severe exacerbation of CSU was next reported when this patient was 10 weeks pregnant. The dose of omalizumab was then escalated to 450 mg/month with informed consent, which controlled the wheals within 3 days. 

This dose had to be maintained until her delivery and the lady gave birth to a full-term healthy male infant. Breastfeeding was not contraindicated in this patient.  

Source: Liao SL, Yu M, Zhao ZT, et al. Case report: Omalizumab for chronic spontaneous urticaria in pregnancy. Front Immunol. 2021;12:652973.