D3.344 - Biological therapy for severe chronic spontaneous urticaria associated with autoimmune atrophic gastritis

Chronic spontaneous urticaria (CSU) may be associated with autoimmune disorders, though its association with autoimmune atrophic gastritis (AAG) has been less studied. The aim of this study is to analyze the association between CSU and AAG and the efficacy of omalizumab in these patients.

A retrospective analysis of four patients with severe CSU and associated AAG was done. Clinical and laboratory results, total IgE, blood counts, vitamin B12 levels, inflammatory markers (C-reactive protein, D-dimer), andautoantibody titers to intrinsic factor and gastric parietal cells, were updated. Histological confirmation of AAG was established. Autologous serum skin tests (ASST) were conducted to assess autoreactivity. Due to antihistamine resistance, omalizumab was given in an initial dose of 300 mg, followed by 150 mg every four weeks to all the patients. Urticaria severity was assessed by the UAS7 score.

All the CSU patients were diagnosed as having AAG. Three patients presented symptom relief and reduction in UAS7 score from 42 to 0 after the first omalizumab injection, with a patient responding after the second dose. Treatment led to improvement in quality of life and long-term disease control. 

The connection between CSU and AAG needs to be more thoroughly investigated to enhance diagnosis and treatment. Omalizumab demonstrated effective and immediate symptom control, solidifying its role in the management of autoimmune CSU.