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are important for diagnosis&#44; treatment&#44; and prognosis&#44; and can be used to rule out other photodermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Second-generation H<span class="elsevierStyleInf">1</span> antihistamines are the first-line treatment for inducible chronic SU&#44; just as they are for other forms of inducible chronic urticaria&#46; However&#44; most patients require either high doses or combinations of different antihistamines&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> An alternative first-line approach is tolerance induction through phototherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> The use of omalizumab has also been described in several case reports and small case series of patients in recent years&#44; with varying results&#46; The principle underlying this treatment is based on a hypothetic role for immunoglobulin &#40;Ig&#41; E in the pathogenesis of inducible chronic urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Descriptions</span><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical data for 3 patients with severe SU refractory to H<span class="elsevierStyleInf">1</span> antihistamines treated in our department over a period of 5 years are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 1 had SU induced by visible light in which neither H<span class="elsevierStyleInf">1</span> antihistamines nor phototherapy proved effective&#46; Following treatment with omalizumab&#44; however&#44; she exhibited clear signs of clinical improvement &#40;she was able to tolerate sunlight for 10 times longer than before&#41; and improved test results after photoprovocation testing&#46; Patient 2 had SU to visible light triggered by indoor lights &#40;fluorescents and LEDs&#41; that prevented her from spending time in the sun&#46; After treatment with omalizumab&#44; she experienced an increase in tolerance of exposure to both indoor lights and sunlight&#46; She is now able to remain in the sun for up to 5<span class="elsevierStyleHsp" style=""></span>hours&#44; something that she had not been able to do for 15 years&#46; She also showed improved objective health-related quality of life scores on the Skindex-29 compared with baseline&#44; with a 23&#37; improvement noted for overall quality of life&#44; and additional improvements in the Symptoms&#44; Emotions&#44; and Functioning domains&#46; Patient 3&#44; whose case has been previously published&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> had SU due to UV-B and UV-A and a very low MUD that limited the use of phototherapy&#46; She had responded poorly to H<span class="elsevierStyleInf">1</span> antihistamines&#46; She was treated twice with omalizumab but showed no response on either occasion&#46; In addition&#44; she developed a mild local reaction after the first injection in the form of pruritic wheals that resolved spontaneously&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">In our review of the literature&#44; we identified 16 patients with SU treated with omalizumab &#40;8 case reports and 3 case series&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#8211;14</span></a> Fourteen of the patients were adults and 2 were children&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a> The treatment doses varied between 150<span class="elsevierStyleHsp" style=""></span>mg&#47;mo<span class="elsevierStyleSup">7</span> and 800<span class="elsevierStyleHsp" style=""></span>mg&#47;mo&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Varying measures of clinical response were used&#44; and not all authors reported on this aspect of treatment&#46; Most authors used subjective criteria based on patient-reported manifestations or other health-related quality of life measures&#46; Others used phototesting<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#8211;9</span></a> or the Urticaria Activity Score 7&#44; which is a validated tool for evaluating chronic urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Of the 16 patients&#44; 12 &#40;75&#37;&#41; responded either partially or completely to treatment and 5 of these &#40;31&#46;2&#37;&#41; additionally showed negative provocation results&#46; Follow-up time varied from 1 month&#44; in a patient who showed complete response after a single dose&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> to 1 year&#44; in a patient who received 12 monthly doses&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On analyzing the cases reviewed&#44; we observed a certain tendency towards an association between high total baseline IgE levels&#44; albeit variable&#44; and greater response to treatment&#46; Seven of the 8 patients in this subgroup responded to treatment&#44; although it should be noted that some of the responders had normal IgE levels&#44; while some of the nonresponders &#40;like patient &#35;3 in our series&#41; had elevated levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">No severe adverse effects were mentioned in the cases reviewed&#44; and it is noteworthy that the treatment proved safe in the 2 pediatric cases described&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; Aubin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> recently reported on results from a phase II clinical trial investigating the use of omalizumab &#40;300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo for 2 months&#41; in 10 patients with SU studied by phototesting and photoprovocation &#40;action spectra&#58; UV-A&#44; UV-B&#44; and polychromatic solar spectrum&#41;&#46; The primary endpoint was the proportion of patients who did not develop SU lesions after photoprovocation with a UV radiation dose 10 times higher than the baseline MUD after 12 weeks of treatment&#46; Approximately 40&#37; of the patients showed an initial clinical improvement&#44; but the efficacy results based on the primary endpoint showed no significant differences&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; despite the limited data available from case reports and small case series on the characteristics and results of SU treatment with omalizumab&#44; the clinical response rate of 75&#37; based on reports in the literature to date is promising&#46; The 3 patients described in our series are a selection of patients with severe SU treated at our department and omalizumab proved effective in 2 of them&#46; Response was slower than that typically described for spontaneous chronic urticaria&#44; with improvement observed after 3 doses &#40;patient &#35;1&#41; or 5 doses &#40;patient &#35;2&#41;&#46; Both patients are satisfied with the results and wish to continue treatment&#46; Omalizumab may therefore be a potentially safe and useful treatment for patients with severe SU that is refractory to conventional treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of humans and animals</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purpose of this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their hospital&#39;s protocol on the publication of data concerning patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">Dr de Argila has worked as a clinical advisor for Novartis and also participated in clinical trials sponsored by this company&#46; The other authors declare no conflicts of interest&#46;</p></span></span>"
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          "palabras" => array:3 [
            0 => "Inducible chronic urticaria"
            1 => "Omalizumab"
            2 => "Solar urticaria"
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            0 => "Urticaria cr&#243;nica inducible"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report 3 cases of solar urticaria in which there was no response or limited response to first-line treatments with high-dose H<span class="elsevierStyleInf">1</span> antihistamines or phototherapy&#46; The patients were then treated with omalizumab&#46; Symptoms improved in 2 patients&#44; whose tolerance to sunlight increased considerably&#59; quality of life clearly improved for 1 of these patients&#46; The third experienced no improvement and developed a mild local reaction to the injected medication&#46; We conclude that omalizumab may offer a potentially safe&#44; useful alternative for patients with solar urticaria who do not respond to conventional therapy&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presentan 3 pacientes con urticaria solar que o no hab&#237;an respondido adecuadamente o presentaban limitaciones a los tratamientos de primera l&#237;nea &#40;antihistam&#237;nicos H1 a dosis altas o fototerapia&#41;&#44; que fueron tratados con omalizumab&#46; Dos de ellos mejoraron cl&#237;nicamente con un aumento muy importante de la tolerancia a la luz&#44; uno de ellos con clara mejor&#237;a de la calidad de vida&#46; El otro paciente no mejor&#243; y desarroll&#243; una reacci&#243;n local leve a la medicaci&#243;n inyectada&#46; Omalizumab puede ser por tanto una alternativa terap&#233;utica potencialmente &#250;til y segura en urticarias solares graves no respondedoras al tratamiento convencional&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rodr&#237;guez-Jim&#233;nez P&#44; Chicharro P&#44; P&#233;rez-Plaza A&#44; de Argila D&#46; Respuesta a omalizumab en 3 casos de urticaria solar&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;e53&#8211;e55&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ARC&#44; allergic rhinoconjunctivitis&#59; Com&#44; comorbid conditions&#59; FL&#44; fluorescent light&#59; H<span class="elsevierStyleInf">1</span>A&#44; H<span class="elsevierStyleInf">1</span> antihistamines&#59; IgE&#44; immunoglobulin E&#59; MUD&#44; minimal urticaria dose&#59; PLE&#44; polymorphic light eruption&#59; PT&#44; previous treatment&#59; TsO&#44; time since onset&#59; Unr&#44; unremarkable&#59; VL&#44; visible light&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Com&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TsO&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MUD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IgE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose During Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ARC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A PT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wheal after 30<span class="elsevierStyleHsp" style=""></span>min with VL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">502<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 12 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete with negative provocation test results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wheal after 30<span class="elsevierStyleHsp" style=""></span>min with FL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;2<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 6 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B&#44; 10<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&#59; UV-A&#44; &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;6<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&#59; SS&#44; &#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1382<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150<span class="elsevierStyleHsp" style=""></span>mg&#47;2<span class="elsevierStyleHsp" style=""></span>wk 1&#46;5 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No clinical or objective response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 4 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Solar Urticaria Treated With Omalizumab&#46;</p>"
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                      "titulo" => "Solar urticaria"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Botto"
                            1 => "E&#46; Warshaw"
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                      "titulo" => "The definition&#44; diagnostic testing&#44; and management of chronic inducible urticarias - The EAACI&#47;GA2LEN&#47;EDF&#47;UNEV consensus recommendations 2016 update and revision"
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                            4 => "C&#46; Grattan"
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                      "titulo" => "Failure of omalizumab in ultraviolet-induced severe solar urticaria"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; P&#233;rez-Plaza"
                            1 => "M&#46;J&#46; Concha-Garz&#243;n"
                            2 => "G&#46; Solano-L&#243;pez"
                            3 => "D&#46; De Argila"
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e- Case Report
Response to Omalizumab in Solar Urticaria: Report of 3 Cases
Respuesta a omalizumab en 3 casos de urticaria solar
P. Rodríguez-Jiménez
Autor para correspondencia
, P. Chicharro, A. Pérez-Plaza, D. de Argila
Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain
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    "titulo" => "Response to Omalizumab in Solar Urticaria&#58; Report of 3 Cases"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Solar urticaria &#40;SU&#41; is an uncommon chronic inducible urticaria characterized by the development of wheals after exposure to sun radiation&#44; visible light&#44; or UV radiation&#46; Because the condition is rare&#44; there are no epidemiological data on incidence or prevalence rates&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> although varying figures of between 2&#46;3&#37; and 17&#46;8&#37; have been reported within the group of photodermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Lesions typically appear within minutes of exposure and the most common action spectra are visible light and UV-A&#46; Action spectrum and minimal urticaria dose &#40;MUD&#41; are important for diagnosis&#44; treatment&#44; and prognosis&#44; and can be used to rule out other photodermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Second-generation H<span class="elsevierStyleInf">1</span> antihistamines are the first-line treatment for inducible chronic SU&#44; just as they are for other forms of inducible chronic urticaria&#46; However&#44; most patients require either high doses or combinations of different antihistamines&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> An alternative first-line approach is tolerance induction through phototherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> The use of omalizumab has also been described in several case reports and small case series of patients in recent years&#44; with varying results&#46; The principle underlying this treatment is based on a hypothetic role for immunoglobulin &#40;Ig&#41; E in the pathogenesis of inducible chronic urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Descriptions</span><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical data for 3 patients with severe SU refractory to H<span class="elsevierStyleInf">1</span> antihistamines treated in our department over a period of 5 years are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 1 had SU induced by visible light in which neither H<span class="elsevierStyleInf">1</span> antihistamines nor phototherapy proved effective&#46; Following treatment with omalizumab&#44; however&#44; she exhibited clear signs of clinical improvement &#40;she was able to tolerate sunlight for 10 times longer than before&#41; and improved test results after photoprovocation testing&#46; Patient 2 had SU to visible light triggered by indoor lights &#40;fluorescents and LEDs&#41; that prevented her from spending time in the sun&#46; After treatment with omalizumab&#44; she experienced an increase in tolerance of exposure to both indoor lights and sunlight&#46; She is now able to remain in the sun for up to 5<span class="elsevierStyleHsp" style=""></span>hours&#44; something that she had not been able to do for 15 years&#46; She also showed improved objective health-related quality of life scores on the Skindex-29 compared with baseline&#44; with a 23&#37; improvement noted for overall quality of life&#44; and additional improvements in the Symptoms&#44; Emotions&#44; and Functioning domains&#46; Patient 3&#44; whose case has been previously published&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> had SU due to UV-B and UV-A and a very low MUD that limited the use of phototherapy&#46; She had responded poorly to H<span class="elsevierStyleInf">1</span> antihistamines&#46; She was treated twice with omalizumab but showed no response on either occasion&#46; In addition&#44; she developed a mild local reaction after the first injection in the form of pruritic wheals that resolved spontaneously&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">In our review of the literature&#44; we identified 16 patients with SU treated with omalizumab &#40;8 case reports and 3 case series&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#8211;14</span></a> Fourteen of the patients were adults and 2 were children&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a> The treatment doses varied between 150<span class="elsevierStyleHsp" style=""></span>mg&#47;mo<span class="elsevierStyleSup">7</span> and 800<span class="elsevierStyleHsp" style=""></span>mg&#47;mo&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Varying measures of clinical response were used&#44; and not all authors reported on this aspect of treatment&#46; Most authors used subjective criteria based on patient-reported manifestations or other health-related quality of life measures&#46; Others used phototesting<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#8211;9</span></a> or the Urticaria Activity Score 7&#44; which is a validated tool for evaluating chronic urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Of the 16 patients&#44; 12 &#40;75&#37;&#41; responded either partially or completely to treatment and 5 of these &#40;31&#46;2&#37;&#41; additionally showed negative provocation results&#46; Follow-up time varied from 1 month&#44; in a patient who showed complete response after a single dose&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> to 1 year&#44; in a patient who received 12 monthly doses&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On analyzing the cases reviewed&#44; we observed a certain tendency towards an association between high total baseline IgE levels&#44; albeit variable&#44; and greater response to treatment&#46; Seven of the 8 patients in this subgroup responded to treatment&#44; although it should be noted that some of the responders had normal IgE levels&#44; while some of the nonresponders &#40;like patient &#35;3 in our series&#41; had elevated levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">No severe adverse effects were mentioned in the cases reviewed&#44; and it is noteworthy that the treatment proved safe in the 2 pediatric cases described&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; Aubin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> recently reported on results from a phase II clinical trial investigating the use of omalizumab &#40;300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo for 2 months&#41; in 10 patients with SU studied by phototesting and photoprovocation &#40;action spectra&#58; UV-A&#44; UV-B&#44; and polychromatic solar spectrum&#41;&#46; The primary endpoint was the proportion of patients who did not develop SU lesions after photoprovocation with a UV radiation dose 10 times higher than the baseline MUD after 12 weeks of treatment&#46; Approximately 40&#37; of the patients showed an initial clinical improvement&#44; but the efficacy results based on the primary endpoint showed no significant differences&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; despite the limited data available from case reports and small case series on the characteristics and results of SU treatment with omalizumab&#44; the clinical response rate of 75&#37; based on reports in the literature to date is promising&#46; The 3 patients described in our series are a selection of patients with severe SU treated at our department and omalizumab proved effective in 2 of them&#46; Response was slower than that typically described for spontaneous chronic urticaria&#44; with improvement observed after 3 doses &#40;patient &#35;1&#41; or 5 doses &#40;patient &#35;2&#41;&#46; Both patients are satisfied with the results and wish to continue treatment&#46; Omalizumab may therefore be a potentially safe and useful treatment for patients with severe SU that is refractory to conventional treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of humans and animals</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purpose of this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their hospital&#39;s protocol on the publication of data concerning patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">Dr de Argila has worked as a clinical advisor for Novartis and also participated in clinical trials sponsored by this company&#46; The other authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report 3 cases of solar urticaria in which there was no response or limited response to first-line treatments with high-dose H<span class="elsevierStyleInf">1</span> antihistamines or phototherapy&#46; The patients were then treated with omalizumab&#46; Symptoms improved in 2 patients&#44; whose tolerance to sunlight increased considerably&#59; quality of life clearly improved for 1 of these patients&#46; The third experienced no improvement and developed a mild local reaction to the injected medication&#46; We conclude that omalizumab may offer a potentially safe&#44; useful alternative for patients with solar urticaria who do not respond to conventional therapy&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presentan 3 pacientes con urticaria solar que o no hab&#237;an respondido adecuadamente o presentaban limitaciones a los tratamientos de primera l&#237;nea &#40;antihistam&#237;nicos H1 a dosis altas o fototerapia&#41;&#44; que fueron tratados con omalizumab&#46; Dos de ellos mejoraron cl&#237;nicamente con un aumento muy importante de la tolerancia a la luz&#44; uno de ellos con clara mejor&#237;a de la calidad de vida&#46; El otro paciente no mejor&#243; y desarroll&#243; una reacci&#243;n local leve a la medicaci&#243;n inyectada&#46; Omalizumab puede ser por tanto una alternativa terap&#233;utica potencialmente &#250;til y segura en urticarias solares graves no respondedoras al tratamiento convencional&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Com&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TsO&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MUD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IgE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose During Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ARC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A PT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wheal after 30<span class="elsevierStyleHsp" style=""></span>min with VL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">502<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 12 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete with negative provocation test results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wheal after 30<span class="elsevierStyleHsp" style=""></span>min with FL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;2<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 6 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H<span class="elsevierStyleInf">1</span>A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B&#44; 10<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&#59; UV-A&#44; &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;6<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&#59; SS&#44; &#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mj&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1382<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150<span class="elsevierStyleHsp" style=""></span>mg&#47;2<span class="elsevierStyleHsp" style=""></span>wk 1&#46;5 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No clinical or objective response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>mg&#47;mo 4 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Solar Urticaria Treated With Omalizumab&#46;</p>"
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ISSN: 15782190
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