The effect of omalizumab treatment on inflammatory parameters in urticarial diseases: a retrospective study

Introduction
Chronic spontaneous urticaria (CSU) and urticarial vasculitis (UV) are chronic inflammatory skin disorders. Monoclonal anti-IgE therapy is widely approved for CSU and is increasingly investigated for its broader immunomodulatory effects.

Aim
This study aimed to evaluate the impact of anti-IgE therapy on systemic inflammatory markers, including complete blood count (CBC)-derived ratios and C-reactive protein (CRP), in patients with CSU and UV.

Material and methods
In this retrospective study, 80 patients (67 with CSU, 13 with UV) who received anti-IgE therapy for at least 12 weeks were analysed. Pre- and post-treatment values of hematologic parameters (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-monocyte ratio [NMR], lymphocyte-to-monocyte ratio [LMR], mean platelet volume [MPV], red cell distribution width [RDW]) and CRP were compared. Correlation analyses were also performed.

Results
In the CSU group, significant reductions were observed in neutrophil count, CRP, NLR, PLR, and NMR, whereas lymphocyte count increased (p < 0.05). In UV patients, NLR decreased significantly, while other parameters, including CRP, showed no statistically significant changes. A positive correlation between CRP and NLR was detected in the CSU group. No significant differences were found in MPV, RDW, LMR, eosinophils, or basophils.

Conclusions
Anti-IgE therapy demonstrated measurable anti-inflammatory effects in CSU, reflected by reductions in CRP and CBC-derived markers, which may serve as accessible biomarkers for monitoring treatment response. The effect was less evident in UV, possibly due to distinct disease mechanisms. Larger prospective studies in UV populations are warranted.