T cell activity in successful treatment of chronic urticaria with omalizumab

We have read the interesting manuscript recently published in Clinical and Molecular Allergy entitled "Down regulation of the high-affinity IgE receptor associated with successful treatment of chronic idiopathic urticaria with omalizumab" [1]. The study demonstrated the effectiveness of omalizumab in treating chronic idiopathic urticaria and the temporal relationship between improvement and down regulation of the high affinity IgE receptor (FcεRI). Omalizumab is a recombinant humanized monoclonal antibody that blocks free-serum immunoglobulin E (IgE) through the high-affinity Fc receptor from attaching to mast cells and prevents IgE-mediated inflammatory changes [2]. The FDA approved only specific indications for omalizumab use including patients older than 12 years with moderate-persistent to severe-persistent asthma with a positive skin test or in vitro reaction to a perennial aeroallergen and be symptomatic with inhaled corticosteroids.However, anti-IgE appears to provide a therapeutic option for cases of many allergic diseases and conditions in which IgE plays a significant role. Although, the potential use of omalizumab in other IgE-mediated conditions is being investigated [3,4] and trials in allergic rhinitis are running, omalizumab is currently been evaluated for treating food allergy including peanut allergy, latex allergy, atopic dermatitis, and chronic urticaria [3,5,6].We would like to present a 35-year-old woman with findings of rhinoconjunctivitis and episodic asthma by mite sensitization from childhood, severe chronic urticaria and angioedema since November 1999 with normal initial study conducted in 2000 (biochemistry, haemotology, serology and microbiology analysis). Poor control was obtained with conventional treatments (antihistamines and oral corticosteroids). Subsequently, the patient consulted several specialists (dermatologists) without success and was re-evaluated by Allergology during hospitalization caused by severe urticaria angioedema exa