Ragıp Ertaş

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http://dx.doi.org/10.5772/68015

#### **Abstract**

The crucial position of IgE within the pathogenesis of allergic diseases made it a key target for therapy. The inhibition of the allergic inflammatory cascade by anti-immunoglobulin E (IgE) therapy is a new and promising concept in the treatment of these diseases. Currently available anti-IgE agent omalizumab has been started to be used in past 3 years in the cases of chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU), resistant to the first-, second-, and some third-line treatments. The use of omalizumab as an effective and safe biological therapy for inadequately controlled severe, persistent patients with CSU and CINDU provided a valuable new treatment option for these patients. However, the data about possible mechanisms of anti-IgE therapy in these patients, treatment strategies and dose regimens of anti-IgE therapy are different, and special patient groups and possible side effects are still insufficient. Also, studies about possible future anti-IgE treatment options are ongoing in CSU.

**Keywords:** chronic urticaria, anti-IgE therapy, omalizumab, management, new anti-IgE agents

### **1. Introduction**

Chronic spontaneous urticaria (CSU) is defined as the spontaneous occurrence of itchy wheals, angioedema, or both for more than 6 weeks [1, 2]. More than 5 million people only in Europe suffer from CSU, especially its negative effects are on quality of life and sleep, school and work performance and daily life activities, and social relationships [3]. Recently, inside the EAACI/GA(2) LEN/EDF/WAO Guideline, it has been endorsed that nonsedating H1 antihistamines ought to be used for the first-line treatment of CSU and doses of H1 antihistamines can be increased by four-fold as the second-line treatment till symptoms can be kept under control completely [1, 4]. When these increased doses of H1 antihistamines fail,

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one of the recommended therapies as the third-line treatment is omalizumab. It is the only available agent of anti-immunoglobulin E (IgE) at the current time [3, 4].
