A 30-year-old woman with chronic spontaneous urticaria is uncontrolled on high-dose second-generation antihistamines (4× standard dose). According to current EAACI/GA²LEN guidelines, the next step in management is:
- A Addition of oral prednisolone 40 mg daily for 2 weeks
- B Ciclosporin 3–5 mg/kg/day
- C Omalizumab (anti-IgE) 300 mg subcutaneously every 4 weeks ✓
- D Montelukast as add-on therapy
Correct answer: C. Omalizumab (anti-IgE) 300 mg subcutaneously every 4 weeks
Explanation
Per 2022 EAACI urticaria guidelines (stepwise approach): Step 1 is standard-dose non-sedating second-generation H1-antihistamine (sgAH); Step 2 is updosing sgAH up to 4×; Step 3 (if still uncontrolled) is addition of omalizumab 300 mg SC every 4 weeks. Omalizumab is approved for refractory chronic spontaneous urticaria (CSU) and works by reducing free IgE, downregulating FcεRI on mast cells. Cyclosporine is Step 4 for omalizumab-non-responders. Systemic steroids are for short-term flare control only, not maintenance.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.