Ann Dermatol.  2019 Jun;31(3):335-338. 10.5021/ad.2019.31.3.335.

Omalizumab as a Succesfull Therapy in Normocomplementemic Urticarial Vasculitis: A Series of Four Patients and Review of the Literature

• Degirmentepe EN
• Kızıltac K
• Etikan P
• Singer R
• Memet B
• Kocaturk E

• KMID: 2444868
• DOI: http://doi.org/10.5021/ad.2019.31.3.335

Abstract

Urticarial vasculitis is an eruption characterized by inflamed itchy or painful red papules or plaques that resemble urticaria but last longer than 24 hours and heal with residual pigmentation or purpura. Histopathologically, urticarial vasculitis presents as leukocytoclastic vasculitis with perivascular infiltrate and fibrin deposits. The treatment options are oral antihistamines, oral corticosteroids, dapsone, colchicine and hydroxychloroquine. We report four cases with normocomplementemic urticarial vasculitis who were treated with omalizumab and a brief review of the literature on the use of omalizumab in normocomplementemic urticarial vasculitis.

Keyword

Omalizumab; Urticarial vasculitis

MeSH Terms

Adrenal Cortex Hormones
Colchicine
Dapsone
Fibrin
Histamine Antagonists
Humans
Hydroxychloroquine
Omalizumab*
Pigmentation
Purpura
Urticaria
Vasculitis*
Adrenal Cortex Hormones
Colchicine
Dapsone
Fibrin
Histamine Antagonists
Hydroxychloroquine
Omalizumab

Figure

• 

  Fig. 1 Urticarial plaques and residual hyperpigmentation on the legs.

• 

  Fig. 2 Thickening in the vein walls and perivascular inflammatory cell infiltration, leukocytoclasia and fibrin accumulation (H&E, ×400).

Reference

1. Kocatürk E. Differential diagnosis in urticaria: urticarial vasculitis, neutrophilic urticarial dermatosis and urticarial dermatitis. Turk Klinikleri J Dermatol-Special Top. 2015; 8:26–33.

2. Ghazanfar MN, Thomsen SF. Omalizumab for urticarial vasculitis: case report and review of the literature. Case Rep Dermatol Med. 2015; 2015:576893.

3. Moreno-Suárez F, Pulpillo-Ruiz Á, Zulueta Dorado T, Conejo-Mir Sánchez J. Urticarial vasculitis: a retrospective study of 15 cases. Actas Dermosifiliogr. 2013; 104:579–585.

4. Ramírez Del Pozo ME, Martínez Saenz NP, Vera JG, Tiro JL. 274 vasculitic urticaria treated with omalizumab. Case report. World Allergy Organ J. 2012; 5:Suppl 2. S106.

5. Varricchi G, Detoraki A, Liccardo B, Spadaro G, de Paulis A, Marone G, et al. 275 efficacy of omalizumab in the treatment of urticaria-vasculitis associated to Churg-Strauss Syndrome: a case report. World Allergy Organ J. 2012; 5:Suppl 2. S106–S107.

6. Díez LS, Tamayo LM, Cardona R. [Omalizumab: therapeutic option in chronic spontaneous urticaria difficult to control with associated vasculitis, report of three cases]. Biomedica. 2013; 33:503–512. Spanish.

7. Fueyo-Casado A, Campos-Muñoz L, González-Guerra E, Pedraz-Muñoz J, Cortés-Toro JA, López-Bran E. Effectiveness of omalizumab in a case of urticarial vasculitis. Clin Exp Dermatol. 2017; 42:403–405.

8. Brewer JD, Davis MDP. Urticarial vasculitis. Waltham: UpToDate;cited 2017 Nov 5. Available from: https://www.uptodate.com/contents/urticarial-vasculitis.

9. Wisnieski JJ. Urticarial vasculitis. Curr Opin Rheumatol. 2000; 12:24–31.

10. Zuberbier T, Maurer M. Urticarial vasculitis and Schnitzler syndrome. Immunol Allergy Clin North Am. 2014; 34:141–147.

11. Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013; 368:924–935.

12. Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol. 2013; 132:101–109.

13. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69:868–887.

14. Kaplan AP, Giménez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy. 2017; 72:519–533.

15. Aurich S, Simon JC, Treudler R. Omalizumab does not improve skin lesions in a patient with hypocomplementemic urticarial vasculitis syndrome. J Eur Acad Dermatol Venereol. 2017; 31:e395–e397.

16. Chia JC, Mydlarski PR. Dermatologic uses of omalizumabtitle. J Dermatolog Treat. 2017; 28:332–337.