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Combination therapy of omalizumab with house dust mite immunotherapy in chronic spontaneous urticaria associated with sensitization to dust mites-case series

Chronic spontaneous urticaria (CSU) is a heterogeneous disorder with recurrent pruritic wheals and/or angioedema. The anti-immunoglobulin E (omalizumab) is used in CSU patients resistant to four-fold second-generation anti-histamines. Most clinical trials have experienced relapse after stopping omalizumab treatment. Here, we present a case series of five cases of chronic atopic urticarial concomitant allergic rhinitis and asthma which have shown immunologically significant positivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae. Disease control was achieved (Urticaria Activity Score 7 <6) in four cases by combination therapy of omalizumab with house dust mite (HDM) Allergen Immunotherapy (AIT) and remained sustained for three years on follow-up even after discontinuation of AIT for one year. We hypothesize that this combined therapy may contribute to enhanced clinical efficacy, safety, and faster achievement of disease control in CSU.