D2.355 - Concurrent use of dupilumab and omalizumab in severe atopic dermatitis and severe chronic urticaria

Dupilumab is a widely used biologic agent for severe atopic dermatitis (AD), and Omalizumab is effective in the treatment of severe chronic urticaria (CU). We report a rare case of concurrent chronic urticaria and atopic dermatitis successfully treated with both dupilumab and omalizumab. A 22-year-old woman with a history of Pruritic lichenified skin lesions since infancy was ineffectively treated with topical corticosteroids, a topical calcineurin inhibitor, emollients and cyclosporine. She had occasional hives which were not severe, so no specific treatment was given. Her Eczema Area and Severity Index (EASI) score was 27.2 and her Urticaria Control Test (UCT) score was 14.  Dupilumab treatment started in April 2023. After one month of treatment, AD symptoms improved significantly and were well controlled with dupilumab and moisturizer alone. After 6 months of dupilumab treatment, hives worsened and high-dose antihistamines were ineffective. (UCT 6) Cholinergic urticaria was also present. Treatment with omalizumab was started in November 2023.  Urticaria symptoms improved 2-3 weeks after omalizumab treatment (EASI 5.6, UCT 10). At the 12-month follow-up, she reported a marked improvement in both CU and AD, supported by a significant improvement in symptom scores with an EASI of 1.8, UCT of 14. No treatment-related side effects were reported.