Omalizumab for Chronic Urticaria in Children Younger Than 12 Years.

Chronic urticaria (CU), defined by recurrent wheals, angioedema, or both lasting more than 6 weeks, is subclassified into chronic spontaneous urticaria (CSU) and inducible urticaria (IU). 1 Zuberbier T. Aberer W. Asero R. et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414 Crossref PubMed Scopus (881) Google Scholar CU is disabling and impairs work and school performance. 1 Zuberbier T. Aberer W. Asero R. et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414 Crossref PubMed Scopus (881) Google Scholar Current treatment guidelines recommend a stepwise approach starting with escalating doses of nonsedating antihistamines. 1 Zuberbier T. Aberer W. Asero R. et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414 Crossref PubMed Scopus (881) Google Scholar Omalizumab (anti-IgE monoclonal antibody) is approved as an add-on therapy for patients (≥12 years old) with antihistamine-resistant CSU; however, omalizumab is not approved for CSU in children younger than 12 years. 2 Koski R. Kennedy K.K. Treatment with omalizumab or cyclosporine for resistant chronic spontaneous urticaria. Ann Allergy Asthma Immunol. 2017; 119: 397-401 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar CU in children is not uncommon, 1 Zuberbier T. Aberer W. Asero R. et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414 Crossref PubMed Scopus (881) Google Scholar and up to one-third of patients are antihistamine resistant. 3 Doshi D.R. Weinberger M.M. Experience with cyclosporine in children with chronic idiopathic urticaria. Pediatr Dermatol. 2009; 26: 409-413 Crossref PubMed Scopus (59) Google Scholar For these challenging pediatric patients, therapeutic options are limited, and systemic immunosuppressants with significant adverse effects, such as oral corticosteroids or cyclosporine, are often used. 1 Zuberbier T. Aberer W. Asero R. et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414 Crossref PubMed Scopus (881) Google Scholar , 4 Kulthanan K. Chaweekulrat P. Komoltri C. et al. Cyclosporine for chronic spontaneous urticaria: a meta-analysis and systematic review. J Allergy Clin Immunol Pract. 2018; 6: 586-599 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar In this brief report, we compile the experience of using omalizumab for treating CU in children younger than 12 years through a systematic literature review and a report of our single-practice experience.