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Chronic spontaneous urticaria (CSU; also known as idiopathic urticaria) is characterized by recurring hives and angioedema for longer than 6 weeks. An allergic cause usually is not identified, and as many as 50% of CSU patients probably have an autoimmune cause (i.e., autoantibodies triggering mast cell release). Although such urticaria is self-limited, with a typical duration of 2 to 5 years, it negatively affects quality of life. Only about half of patients improve on high-dose antihistamines. About 60% of antihistamine nonresponders achieve improvement or complete remission with omalizumab (Xolair), which is FDA approved for CSU but is very expensive.
In a retrospective review, researchers analyzed 79 adults with CSU who were unresponsive…