Since 2015, the humanized anti-IgE antibody omalizumab has been released in Italy for individuals suffering with chronic spontaneous urticaria (CSU). This review highlights the unsolved difficulties and unmet therapeutic needs related with omalizumab, as well as practical suggestions for its usage in the treatment of CSU. Although current second-generation H1-antihistamines are the standard of therapy for CSU patients, additional therapies (including omalizumab) may be necessary in many individuals for successful symptom management. Evidence from clinical studies and clinical practice show that the use of omalizumab in patients with CSU who do not respond to H1-antihistamines remains difficult.

Researchers give therapeutic recommendations for the use of omalizumab in patients with CSU based on current international guidelines, omalizumab labeling information, and our clinical practice experience. These include the use of concurrent antihistamine medication, the characterization and management of illness recurrence following treatment, and the care of patients who have a late or no response to treatment.