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Archives of Dermatological Research, vol.318, no.1, 2026 (SCI-Expanded, Scopus)
Omalizumab is commonly used at a standard dose of 300 mg every 4 weeks for chronic spontaneous urticaria (CSU), but a subset of patients requires dose escalation. In this retrospective, single-center observational study, we evaluated 248 adults with CSU treated with omalizumab 300 mg; 213 (85.9%) achieved a clinical response at 300 mg, whereas 35 (14.1%) required escalation to 450 mg to achieve a response. Clinical and laboratory parameters were compared between the non-updosed and updosed groups. Patients who required updosing had lower body mass index (BMI; 25.30 ± 3.63 vs. 27.63 ± 5.21 kg/m², p = 0.004) and lower total IgE levels (81.85 [27.40–180.75] vs. 181 [65.85–385.0] IU/mL, p = 0.004). On ROC analysis, a total IgE cut-off of 71.15 IU/mL predicted dose escalation (p = 0.004) with 73.8% sensitivity and 50.0% specificity, while a BMI cut-off of 26.825 kg/m² predicted escalation (p = 0.018) with 53.5% sensitivity and 77.4% specificity. In multivariable logistic regression, BMI < 26.82 kg/m² was independently associated with a higher likelihood of dose escalation (OR 4.77, 95% CI 1.48–15.39; p = 0.009). In this cohort, patients requiring escalation more often had lower BMI and non-elevated total IgE, with lower BMI remaining independently associated; these findings are hypothesis-generating and warrant confirmation in prospective studies.