Kaplan Allen P, Popov Todor A
aMedical University of South Carolina, Charleston, South Carolina, USA bClinic of Allergy and Asthma, Medical University Sofia, Sofia, Bulgaria.
Curr Opin Allergy Clin Immunol. 2014 Aug;14(4):347-53. doi: 10.1097/ACI.0000000000000083.
Chronic spontaneous urticaria (CSU) has been traditionally managed with antihistamines. Over the years, studies using different formulations and dosing regimens have delineated the limits of their effectiveness, thus emphasizing the need for alternative therapeutic approaches. Data keep accumulating that the monoclonal anti-immunoglobulin E antibody omalizumab, until recently reserved for the treatment of severe atopic asthma, may have a beneficial therapeutic and safety profile for CSU cases resistant to the effect of antihistamines.
Since the beginning of 2013, a host of studies have been published paving the way for licensing of omalizumab for the treatment of CSU. Dose-finding studies have indicated 300 mg monthly as a possible optimal treatment regimen. Efficacy proving randomized controlled trials were further supported by open-label studies confirming its effectiveness in real life. One report has been published so far presenting positive data about the use of another biologic agent, rituximab, depleting the blood stream of B cells, in patients with CSU.
New convincing evidence in support of the efficacy and safety of omalizumab in the treatment of CSU has accumulated over the past year, providing another tool for coping with the antihistamine-resistant cases.
慢性自发性荨麻疹（CSU）传统上使用抗组胺药治疗。多年来，使用不同制剂和给药方案的研究已经明确了其有效性的局限性，因此强调了需要替代治疗方法。越来越多的数据表明，单克隆抗免疫球蛋白E抗体奥马珠单抗（直到最近还仅用于治疗重度特应性哮喘）对于对抗组胺药治疗无效的CSU病例可能具有有益的治疗效果和安全性。
自2013年初以来，已经发表了大量研究，为奥马珠单抗用于治疗CSU的许可铺平了道路。剂量探索研究表明，每月300mg可能是最佳治疗方案。疗效验证随机对照试验得到了开放标签研究的进一步支持，这些研究证实了其在现实生活中的有效性。迄今为止，已有一份报告公布了关于另一种生物制剂利妥昔单抗（可清除CSU患者血液中的B细胞）使用的阳性数据。
过去一年积累了新的令人信服的证据，支持奥马珠单抗治疗CSU的有效性和安全性，为应对抗组胺药治疗无效的病例提供了另一种工具。
