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Vol. 47. Issue 6.
Pages 515-522 (November - December 2019)
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Vol. 47. Issue 6.
Pages 515-522 (November - December 2019)
Original Article
DOI: 10.1016/j.aller.2019.05.003
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Effectiveness and safety of Omalizumab in the treatment of chronic spontaneous urticaria: Systematic review and meta-analysis
N.P.M. Rubinia, L.F.C. Ensinab, E.M.K. Silvac, F. Sanod, D. Solée,
Corresponding author

Corresponding author at: Rua dos Otonis 725, Vila Clementino, São Paulo 04025-002, SP, Brazil.
a School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
b Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
c Division of Emergency and Evidence Based Medicine, EPM-UNIFESP and Researcher of Cochrane Center of Brazil, São Paulo, Brazil
d Nipo-Brazilian Hospital, São Paulo, Brazil
e Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, EPM-UNIFESP, São Paulo, Brazil
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Tables (2)
Table 1. Characteristics of the studies included in the meta-analysis.
Table 2. Summary of the meta-analyses of Omalizumab 300mg in the treatment of Chronic Spontaneous Urticaria.
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Chronic spontaneous urticaria (CSU) affects approximately 1% of the population, affecting both children and adults. Omalizumab (Oma) is a therapeutic option for patients with refractory forms of CSU.


To determine the effectiveness and safety of Oma in the treatment of CSU.


Systematic review (Cochrane Collaboration methodology) of randomized clinical trials comparing Oma to placebo in refractory CSU treatment. The search is based on MEDLINE; EMBASE, Central Cochrane Library, and LILACS. The outcomes evaluated were: control of the illness, adverse events, and quality of life.


Of the 848 identified studies 13 were selected for further review and six were included in the meta-analysis. For all outcomes, high-quality evidence has confirmed that Oma is effective in the treatment of CSU. The dosage of 300mg/month achieved better results; namely a significant reduction in pruritus, papules, and urticaria activity, as well as an increase in the number of patients with a controlled condition, improvement in the quality of life and no differences in adverse events compared to the placebo.


High-quality evidence demonstrates that Oma is effective and safe in the treatment of CSU refractory to therapy with H1 antihistamines.

anti-IgE monoclonal antibody
Chronic urticaria
Full Text

Urticaria is a common disease that affects one in five people at some point in life.1 Its characteristics are the appearance of urticaria, angioedema or both.2 When symptoms persist daily or almost daily for more than six weeks, urticaria is classified as chronic, and has a prevalence ranging from 0.5% to 1%; it is moreover more frequent in females.3

In most chronic urticaria there is no specific trigger (chronic spontaneous urticaria, CSU), whereas in some individuals the symptoms may be induced by well-defined stimuli such as heat, cold, pressure, ultraviolet light, or increased body temperature (induced chronic urticaria). The diagnosis of CSU is exclusively clinical, without the need for routine tests. The diagnostic confirmation of induced urticaria uses specific provocative tests for each of the different types.2

Although the pathophysiology of CSU has not yet been fully elucidated, there is a great deal of evidence pointing to mast cell activation by autoimmune mechanisms. Either IgE class antibodies against its proteins (auto-allergens) or antibodies of the IgG class against the high-affinity receptor for IgE or against IgE itself, once activated, the release of pre- and neo-formed mediator mast cells occurs, including histamine, which is primarily responsible for the symptoms of urticaria.

CSU has a high impact on the patients’ quality of life, significantly interfering with daily professional, school, and social activities. Studies using a specific questionnaire to assess the quality of life in urticaria sufferers indicate that the disease negatively affects aspects such as anxiety, depression, sleep, and self-esteem.4 Thus, symptom control becomes the primary goal of treatment.

Current guidelines recommend second-generation non-sedating antihistamines at usual doses, or up to two to four times as high as first and second lines of treatment, respectively. The response to treatment is evaluated by objective tools such as the Urticaria activity score in seven days (UAS7) and the Urticaria control test (UCT).2 However, up to 40% of patients may not achieve disease control (UAS76 or UCT12) and are considered refractory to treatment.5

Omalizumab (Oma) is an anti-IgE monoclonal antibody, whose clinical and real-life data demonstrate safety and efficacy for the treatment of urticaria refractory to antihistamines. It is recommended as the third line of treatment for CSU.

The objectives of this systematic review, complemented by meta-analysis, were to evaluate the effectiveness and safety of Oma in the treatment of CSU refractory to H1 antihistamine treatment.

Materials and methods

A systematic review was carried out of randomized, placebo-controlled trials (comparator treatment) of patients (12- to 75-year-olds, regardless of sex) with CSU refractory to treatment with antihistamine and treated with Oma and assessing the outcomes at 12 weeks of following, using the Cochrane Collaboration method.6


Evaluated outcomes: response to treatment using the Urticaria Activity Score (evaluates papules and pruritus, 0–3 scale) for seven days (UAS76, maximum value 42),7 complete response (UAS7=0)2; Weekly itch severity score for seven days (WISS; scale from 0 [absent] to 21 [intense])8; Weekly wheal score (scale – none=0; 1–6=1; 7– 12=2 and more than 13=3)9; at least one adverse event and quality of life (Dermatology Life Quality Index).10,11

Search strategy

The search strategy for the relevant studies was carried out with the basis of MEDLINE, EMBASE, CENTRAL Cochrane Library, and LILACS. The search included studies published until April 15, 2018. The uniterms used in the search were: urticaria, chronic urticaria, hives, omalizumab, Xolair, monoclonal antibody, rhuMAb-E25, anti-immunoglobulin E, randomized controlled trial, and antihistamines.

Each of the articles was reviewed, simultaneously and independently by two reviewers (EMKS, MJB), who extracted all data related to population, demographics, and treatment periods. The quality of each trial was determined independently by the two reviewers using The Cochrane Collaboration’s tool for assessing the risk of bias.6

Statistical analysis

For the quantitative analysis the principle of "intention to treat" was used. When possible, the data were summarized in meta-analyses using Review Manager 5.2 software, developed by the Cochrane Collaboration.12 For dichotomous data, the Relative Risk (RR, the proportion of events in the treatment group about the proportion of events in the control group) and its respective Confidence Interval (CI) of 95% (95% CI) were calculated. For the analysis of continuous variables, the means difference with 95% CI was calculated.

The studies’ heterogeneity was evaluated by the Chi-square test (p<0.1 indicates heterogeneity) and the I2 test (>50% represents heterogeneity). Possible causes of heterogeneity are differences in the population, interventions, and evaluations of outcomes.

ResultsSearch strategy

A total of 848 possible references were identified. All abstracts of the articles found were evaluated by the two authors, and of these, 13 articles were selected because they presented the potential to be included in the systematic review.

These articles were obtained in their entirety and evaluated according to the inclusion criterion. In this stage, four articles were excluded with a motive: use of Oma doses equal to those of asthma,13,14 subgroup analysis of the POLARIS study15 and no report of outcomes16 (Fig. 1). Thus, seven studies were included in this systematic review (Table 1), whose results were published in nine articles.8,17–24

Figure 1.

Search results flowchart and studies selection.

Table 1.

Characteristics of the studies included in the meta-analysis.

Study  Type  Omalizumab  Time (weeks)Quality study 
        Treatment  Follow-up  Outcome   
Saini et al. 201117 MYSTIQUE  Multi-center, double-blind, placebo-controlled RCT  90  One dose of 75mg, 150mg, and 300mg  12  High 
Kaplan et al. 20138 GLACIAL  Multi-center, double-blind, placebo-controlled RCT  334  Six doses of 300mg/month  24  24  12  High 
Hide et al. 201322 ASTERIA I  Multi-center, double-blind, placebo-controlled RCT  323  Three doses of 75mg, 150mg, and 300mg  12  16  12  High 
Saini et al. 201518 ASTERIA II  Multi-center, double-blind, placebo-controlled RCT  399  Three doses of 75mg, 150mg, and 300mg  12  16  12  High 
Staubach et al. 201619 X-ACT  Multi-center, double-blind, placebo-controlled RCT  91  Six doses of 300mg/month  24  28  12  Moderate 
Hide et al. 201722 POLARIS  Multi-center, double-blind, placebo-controlled RCT  218  Three doses of 150mg, and 300mg  12  26  12  High 
Metz et al. 201724 MOA  Multi-center, double-blind, placebo-controlled RCT  30  Three doses of 300mg/month  12  20  12  High 

RCT: randomized clinical trial.


The seven included studies totaled 1405 participants with at least a six-month history of CSU, with activity for at least eight consecutive weeks before the study started, refractory to previous use of antihistamines, and with a UAS7 score equal to or greater than 16. Just one study included only patients with at least four episodes of angioedema in the last six months.19,20

Effects of interventions (outcome at 12 weeks)Weekly itch severity score (WISS)

The analysis of Oma’s action in WISS control compared to placebo showed that the 75mg dose was effective and determined a minimal difference (MD)=−1.86 (95% CI: −3.15 to −0.57; p=0.005), data obtained from two studies with 318 participants. A dose of 150mg was also effective: MD=−2.73 (95% CI: −3.74 to −1.73, p<0.0010), data obtained from three studies with 465 participants. A dose of 300mg determined MD=−4.82 (95% CI: −5.66 to −3.98, p<0.001), data obtained from six studies with 917 participants. The dose of 300mg showed better performance. Only the meta-analysis with the 75mg dose presented some heterogeneity, so the fixed model of analysis was used.

Weekly wheal score (WWS)

Oma was effective in controlling the mean number of weekly papules compared to a placebo at doses of 150mg and 300mg, which did not occur with 75mg (MD=−2.00 [95% CI: −4.10 to 0.10; p=0.06] taken from a study with 161 participants). With 150mg MD=−3.60 (95% CI: −5.11 to −2.09; p<0.001) was significant and data was obtained from two studies with 305 participants. Also, with 300mg MD=−5.90 (95% CI: −7.06 to −4.75; p<0.001), obtained from five studies with 756 participants. No significant heterogeneity was observed in the analyses, so the fixed model was used.

Response to treatment (UAS76)

Oma was shown to be effective in CSU control in the three doses used. A dose of 75mg determined RR=1.74 (95% CI: 1.11–2.73, p=0.02), referring to data obtained from two studies with 318 participants. The 150mg dose documented RR=2.56 (95% CI: 1.85–3.56; p<0.001) from three studies with 465 participants. The 300mg dose indicated RR=3.85 (95% CI: 3.85– 5.10; p<0.001) obtained from four studies with 797 participants (Graph 1). No significant heterogeneity was observed in the analyses, so the fixed model was used.

Graph 1.

Response to treatment (UAS76) – Omalizumab associated with antihistamine H1 vs. Placebo associated with antihistamine H1–12 weeks.

Complete response (UAS7=0)

The Oma showed evidence of effectiveness in obtaining complete CSU response, in all doses evaluated, although the 300mg dose showed a greater proportion of participants. With 75mg the RR=3.17 (95% CI: 1.08– 9.31; p=0.04), obtained from a study with 17 participants. The 150mg dose showed RR=4.47 (95% CI: 2.03–9.84; p<0.001) derived from two studies and 306 participants. The 300mg dose documented RR=6.01 (95% CI: 3.29–10.98; p<0.0010) obtained from three studies with 740 participants (Graph 2). No significant heterogeneity was observed in the analyses, so the fixed model was used.

Graph 2.

Complete response to treatment (UAS7=0) – Omalizumab associated with antihistamine H1 vs. Placebo associated with antihistamine H1–12 weeks.

Adverse events – at least one

The three Oma dosages evaluated were equal to the placebo for the frequency of adverse events. The most reported events were gastrointestinal manifestations, headache, infection at the site of administration, and skin changes. With the 75mg dose, we observed RR=1.07 (95% CI: 0.91–1.26; p=0.34) derived from two studies with 305 patients. The 150mg dose revealed RR=1.14 (95% CI: 1.00–1.29, p=0.05) obtained from three studies with 473 patients. The 300mg dose had RR=1.05 (95% CI: 0.96–1.14, p=0.34) obtained from six studies with 922 patients. No significant heterogeneity was observed in the analyses, so the fixed model was used.

Quality of life

Evidence shows that Oma acts effectively on the participants’ quality of life when used in doses of 150mg and 300mg. With a dose of 75mg MD=−1.40 (95% CI: −3.75 to 0.95, p=0.24) was not significant – data extracted from a study with 150 participants. At the dose of 150mg MD=−1.56 (95% CI: −2.58 to −0.53; p=0.003) it was significant and obtained from three studies with 454 participants. In the case of the dose of 300mg, MD=−3.50 (95% CI: −4.40 to −2.61; p<0.001) it was significant and obtained from four studies with 804 participants (Graph 3). No significant heterogeneity was observed in the analyses, so the fixed model was used.

Graph 3.

Quality of life – Omalizumab associated with antihistamine H1 vs. Placebo associated with antihistamine H1–12 weeks.


Of the seven studies included in this meta-analysis, six showed a low risk of bias and only one was considered to be at moderate risk.19 This fact alone assures us of having high quality evidence in favor of Oma. Furthermore, the consistency of the results obtained by the various included studies, with little heterogeneity, and the analysis of a large number of participants (N=1405) reinforce this statement.

This study revealed, with high-quality evidence, that Oma is effective in the treatment of CSU in those patients refractory to antihistamine treatment when compared to a placebo. Although the antihistamines’ refractoriness was variably defined in the different evaluated studies, the results obtained were all significant. This is an important finding because the consensus recommendation is that Oma is indicated only in patients who do not respond to high doses of antihistamines, and some of the studies used in this systematic review and meta-analysis did not include this patient profile type. On the other hand, several real-life studies corroborate the efficacy data observed in clinical studies, even in refractory patients at high doses.

Different dosages were evaluated in pivotal studies, the most efficient being 300mg every four weeks (Table 2). For this reason, in part of the studies there is no comparison between different doses, only between the 300mg dose and the placebo. It is also interesting to note that in real-life studies this too was the dose with the best-observed response.25

Table 2.

Summary of the meta-analyses of Omalizumab 300mg in the treatment of Chronic Spontaneous Urticaria.

Outcome  Effect  95% CI  p 
Weekly Itch Severity Score (WISS)  MD=−4.82  −5.66 to −3.98  <0.001 
Weekly Wheal Score (WWS)  MD=−5.90  −7.06 to −4.75  <0.001 
Treatment response (USA76)  RR=3.85  2.91 to 15.10  <0.001 
Complete response (USA7=0)  RR=6.01  3.29 to 10.98  <0.001 
At least one adverse effect  RR=1.05  0.96 to 1.14  0.34 
Quality of life  MD=−3.50  −4.40 to −2.61  <0.001 

MD: minimum difference; 95% CI: 95% confidence interval; RR: relative risk; NNT: number needed to treat.

The outcomes to assess the effectiveness and safety of Oma treatment used here have been used by most studies, which in a way, facilitated the assessments. It is important to use standardized tools to assess disease activity and control, as well as to evaluate quality of life. The consensus-recommended tools for use not only in clinical studies, but also in clinical practice are UAS7, UCT, and DLQI (Dermatology Quality of Life Index), or CU-QoL (Chronic Urticaria Quality of Life).

The selected outcomes chosen for the identification of studies we took into account were systematically elected by other authors, i.e. disease activity (UAS7, UAS76, UAS7=0, WISS, WWSS), quality of life and adverse events. Similar to other researchers, we have selected, by definition, the manifestation of at least one adverse event.

The adverse effect profile and a frequency similar to that observed in the placebo group confirm Oma’s safety in the recommended dosing regimen for CSU treatment. The primary adverse events were mild and included gastrointestinal manifestations, headache, the reaction at the application site, and skin changes.

The quality of life of patients with urticaria or dermatological disease has been evaluated by several instruments: Dermatology Quality of Life Index (DQLI) (1011), Children’s Dermatology Life Quality Index (CDLQI),26 Dermatology Quality Of Life Scales (DQOLS),27 Dermatology-Specific Quality of Life (DSQL),28 Skindex-29,29 Skindex-16,30 Chronic Urticaria and Quality of Life Questionnaire (CU-Q2oL),31 Urticaria Severity Score (USS),32 among others.33 This fact makes it difficult to compare results obtained by studies using different instruments in the evaluation of the quality of life. Most of the studies included in this one employed DLQI20–23 except for Staubach et al.,19 who used the (CU-Q2oL) and Angioedema Quality of Life (AE-QoL)34 and therefore, were not included in the analysis.

Our results are compatible with those of other published systematic reviews, although they used different methods.35–37 The main difference of this review is the update, with the inclusion of recent studies.15,19

The mean duration of CSU is estimated to be between six months and five years and may be longer in more severe cases, especially in patients with concomitant angioedema, association with induced urticaria, or with a positive autologous serum test.38–40 This entails the substantial commitment of time from professional, social, leisurely activities, and family life, besides the direct and indirect costs, due to the type of treatment and remote nature of the work. These data indicate the importance of a medication that controls symptoms, improves quality of life and does not lead to serious adverse effects. Anti-IgE therapy in CSU is an effective and safe option for cases refractory to treatment with high doses of antihistamines. The only present limitation is its high cost. Efforts are needed for careful incorporation into the public and supplementary health networks.

Conflict of interest

The authors have no conflict of interest to declare.

M. Sanchez-Borges, R. Asero, I.J. Ansotegui, I. Baiardini, J.A. Bernstein, G.W. Canonica, et al.
Diagnosis and treatment of urticaria and angioedema: a worldwide perspective.
World Allergy Organ J, 5 (2012), pp. 125-147
T. Zuberbier, W. Aberer, R. Asero, A.H. Abdul Latiff, D. Baker, B. Ballmer-Weber, et al.
The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.
Allergy, 73 (2018), pp. 1393-1414
M.M. Balp, N.L. da Silva, J. Vietri, H. Tian, L.F. Ensina.
The burden of chronic urticaria from Brazilian patients’ perspective.
Dermatol Ther (Heidelb), 69 (2017), pp. 1-11
G.A. Dias, G.V. Pires, S.O. Valle, S.D. Dortas Jr, S. Levy, A.T. França, et al.
Impact of chronic urticaria on the quality of life of patients followed up at a university hospital.
An Bras Dermatol, 91 (2016), pp. 754-759
M. Staevska, T.A. Popov, T. Kralimarkova, C. Lazarova, S. Kraeva, D. Popova, et al.
The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria.
J Allergy Clin Immunol, 125 (2010), pp. 676-682
Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011],
S.D. Mathias, R.D. Crosby, J.L. Zazzali, M. Maurer, S.S. Saini.
Evaluating the minimally important difference of the urticaria activity score and other measures of disease activity in patients with chronic idiopathic urticaria.
Ann Allergy Asthma Immunol, 108 (2012), pp. 20-24
A. Kaplan, D. Ledford, M. Ashby, J. Canvin, J.L. Zazzali, E. Conner, et al.
Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy.
J Allergy Clin Immunol, 132 (2013), pp. 101-109
F. Lapi, N. Cassano, V. Pegoraro, N. Cataldo, F. Heiman, I. Cricelli, et al.
Epidemiology of chronic urticaria: results from a Nationwide, population-based study in Italy.
Br J Dermatol, 174 (2016), pp. 996-1004
A.Y. Finlay, G.K. Khan.
Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use.
Clin Exp Dermatol, 19 (1994), pp. 210-216
R. Shikiar, G. Harding, M. Leahy, R.D. Lennox.
Minimal important difference (MID) of the Dermatology Life Quality Index (DLQI): results from patients with chronic idiopathic urticaria.
Health Qual Life Outcomes, 3 (2005), pp. 36
Review Manager (RevMan) [Computer program]. Version 5.2.
The Nordic Cochrane Centre, The Cochrane Collaboration, (2014),
L.M. Gober, P.M. Sterba, J.A. Eckman, S.S. Saini.
Effect of anti-IgE (omalizumab) in chronic idiopathic urticaria (CIU) patients.
J Allergy Clin Immunol, 121 (2008), pp. S147
M. Maurer, S. Altrichter, T. Bieber, T. Biedermann, M. Bräutigam, S. Seyfried, et al.
Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase.
J Allergy Clin Immunol, 128 (2011), pp. 202-209
M. Hide, A. Igarashi, A. Yagami, Y. Chinuki, N. Inomata, A. Fukunaga, et al.
Efficacy and safety of omalizumab for the treatment of refractory chronic spontaneous urticaria in Japanese patients: subgroup analysis of the phase 3 POLARIS study.
Allergol Int, 67 (2018), pp. 243-252
L. Jörg, T. Pecaric-Petkovic, S. Reichenbach, M. Coslovsky, O. Stalder, W. Pichler, et al.
Double-blind placebo-controlled trial of the effect of omalizumab on basophils in chronic urticaria patients.
Clin Exp Allergy, 48 (2018), pp. 196-204
S. Saini, K.E. Rosen, H.J. Hsieh, D.A. Wong, E. Conner, A. Kaplan, et al.
A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria.
J Allergy Clin Immunol, 128 (2011), pp. 567
S.S. Saini, C. Bindslev-Jensen, M. Maurer, J.J. Grob, E. Bulbul Baskan, M.S. Bradley, et al.
Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study.
J Invest Dermatol, 135 (2015), pp. 925
P. Staubach, M. Metz, N. Chapman-Rothe, C. Sieder, M. Bräutigam, J. Canvin, et al.
Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial.
Allergy, 71 (2016), pp. 1135-1144
P. Staubach, M. Metz, N. Chapman-Rothe, C. Sieder, M. Bräutigam, M. Maurer, et al.
Omalizumab rapidly improves angioedema-related quality of life in adult patients with chronic spontaneous urticaria: X-ACT study data.
Allergy, 73 (2018), pp. 576-584
A.Y. Finlay, A.P. Kaplan, L.A. Beck, E.N. Antonova, M.M. Balp, J. Zazzali, et al.
Omalizumab substantially improves dermatology-related quality of life in patients with chronic spontaneous urticaria.
J Eur Acad Dermatol Venereol, 31 (2017), pp. 1715-1721
M. Hide, H.S. Park, A. Igarashi, Y.M. Ye, T.B. Kim, A. Yagami, et al.
Efficacy and safety of omalizumab in Japanese and Korean patients with refractory chronic spontaneous urticaria.
J Dermatol Sci, 87 (2017), pp. 70-78
M. Maurer, K. Rosen, H.J. Hsieh, S. Saini, C. Grattan, A. Gimenez-Arnau, et al.
Omalizumab for the treatment of chronic idiophatic or spontaneous urticaria.
N Engl J Med, 368 (2013), pp. 924-935
M. Metz, P. Staubach, A. Bauer, R. Brehler, J. Gericke, J. Ashton-Chess, et al.
Omalizumab normalizes levels of high affinity immunoglobulin E receptor-positive skin mast cells in patients with chronic spontaneous urticaria: a randomized, double-blind, placebo-controlled study.
J Invest Dermatol, 134 (2014), pp. S30-8
J.A. Bernstein, A. Kavati, M.D. Tharp, B. Ortiz, K. MacDonald, K. Denhaerynck, et al.
Effectiveness of omalizumab in adolescent and adult patients with chronic idiopathic/spontaneous urticaria: a systematic review of’ real-world’ evidence.
Expert Opin Biol Ther, 18 (2018), pp. 425-448
M.S. Salek, S. Jung, L.A. Brincat-Ruffini, L. MacFarlane, M.S. Lewis-Jones, M.K. Basra, et al.
Clinical experience and psychometric properties of the Children’s Dermatology Life Quality Index (CDLQI), 1995-2012.
Br J Dermatol, 169 (2013), pp. 734-759
M. Morgan, R. McCreedy, J. Simpson, R.J. Hay.
Dermatology quality of life scales-a measure of the impact of skin diseases.
Br J Dermatol, 136 (1997), pp. 202-206
R.T. Anderson, R. Rajagopalan.
Development and validation of a quality of life instrument for cutaneous diseases.
J Am Acad Dermatol, 37 (1997), pp. 41-50
M.M. Chren, R.J. Lasek, S.A. Flocke, S.J. Zyzanski.
Improved discriminative and evaluative capability of a refined version of Skindex, a quality of-life instrument for patients with skin diseases.
Arch Dermatol, 133 (1997), pp. 1433-1440
M.M. Chren, R.J. Lasek, A.P. Sahay, L.P. Sands.
Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.
J Cutan Med Surg, 5 (2001), pp. 105-110
I. Baiardini, M. Pasquali, F. Braido, F. Fumagalli, L. Guerra, E. Compalati, et al.
A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-Q2oL).
Allergy, 60 (2005), pp. 1073-1078
S.P. Jariwala, H. Moday, L. de Asis, J. Fodeman, G. Hudes, G. de Vos, et al.
The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria.
Ann Allergy Asthma Immunol, 102 (2009), pp. 475-482
I. Jáuregui, F.J. Ortiz de Frutos, M. Ferrer, A. Giménez-Arnau, J. Sastre, J. Bartra, et al.
Assessment of severity and quality of life in chronic urticaria.
J Investig Allergol Clin Immunol, 24 (2014), pp. 80-86
K. Weller, A. Groffik, M. Magerl, N. Tohme, P. Martus, K. Krause, et al.
Development and construct validation of the angioedema quality of life questionnaire.
Allergy, 67 (2012), pp. 1289-1298
D.C. Carrillo, M.S. Borges, E. García, E. Egea, C.D. Serrano.
Omalizumab vs. placebo in the management of chronic idiopathic urticaria: a systematic review.
World Allergy Organ J, 7 (2014), pp. 72
M.C. Urgert, M.T. van den Elzen, A.C. Knulst, Z. Fedorowicz, E.J. van Zuuren.
Omalizumab in patients with chronic spontaneous urticaria: a systematic review and GRADE assessment.
Br J Dermatol, 173 (2015), pp. 404-415
Z.T. Zhao, C.M. Ji, W.J. Yu, L. Meng, T. Hawro, J.F. Wei, et al.
Omalizumab for the treatment of chronic spontaneous urticaria: a meta-analysis of randomized clinical trials.
J Allergy Clin Immunol, 137 (2016), pp. 1742-1750
P. van der Valk, G. Moret, L. Kiemeney.
The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre.
Br J Dermatol, 146 (2002), pp. 110-113
M. Sanchez-Borges, F. Caballero-Fonseca, A. Capriles-Hulett, L. González-Aveledo, M. Maurer.
Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria.
J Eur Acad Dermatol Venereol, 31 (2017), pp. 964-971
K. Kulthanan, S. Jiamton, N. Thumpimukvatana, S. Pinkaew.
Chronic idiopathic urticaria: prevalence and clinical course.
J Dermatol, 34 (2007), pp. 294-301
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
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