Xolair (omalizumab) is a injectable medicine which is given every 2-4 week under the skin. It was approved by FDA in 2003 for management of chronic moderate to severe allergic asthma. It has been recently approved by FDA to be used in treatment of chronic hives in patients who don’t respond to antihistamines.
Many patients with chronic urticarial appear to respond to usual doses of allergy medications like Claritin, Allegra, Zyrtec, desloratidine or levocetirizine. There are patients who need up to 4 times the usual doses of these antihistamines, or need H2 blockers like cimetidine or ranitidine or leukotriene inhibitors like Singulair or Accolate.
Despite trying these medications, some patients will continue to experience hives. Prior to the availability of Xolair, patient received variety of medications including antidepressants like doxepin, inflammatory or immunosuppressive drugs like corticosteroid, dapsone, cyclosporine and mycophenolate. There is a long list of medications and non-medication therapies available to treat urticarial many of them have been tried in few patients only. Sometimes these drugs help but patients experience difficulty to manage side effects.
Availability of Xolair for urticarial has improved the lives of many patients. It improves hives by 40-50% of the patients. Some patients may see relief as early as week one. 40-50% patients become hive free in 4-12 weeks.
There have been a lot of experience with Xolair in asthma treatment with more than 75,000 doses being given. More than 1,000 patients with chronic hives have also received Xolair. As the drug was approved for hives in 2014, more patients will use the drug and find it useful.
Major side effect is anaphylaxis which occurs in less than 0.5% of the patients. Most reactions occur after the first few injections, occasionally afterwards. Because of the risk of these reactions, the drug is only given in a healthcare facility. Patient need to wait for 2-3 hours in the office after the 1st injection and 1-2 hours after subsequent injections.
Xolair is used in chronic urticarial patients where nothing else works or patient are experiencing side effect with the treatment regimen.