Effect of age on omalizumab response in chronic urticaria: a retrospective comparison between adult and geriatric populations.

BACKGROUND

Chronic urticaria (CU) can occur at any age, but comorbidities, age-related immune changes, and polypharmacy may influence treatment outcomes in older adults. Limited data exist on the effect of age on omalizumab efficacy. This study aimed to evaluate the impact of age on treatment response, safety, and clinical-laboratory features in adult (aged <65 years) and geriatric (aged ≥65 years) CU patients receiving omalizumab.

METHODS

This retrospective study included 153 CU patients who initiated omalizumab between 2019 and 2024 because of resistance to antihistamines. Patients were categorized by age (<65 or ≥65 years) and by Urticaria Control Test (UCT) scores at the 4th month (responders: UCT ≥12; non-responders: UCT <12). Demographic, clinical, and laboratory parameters were compared between groups.

RESULTS

The median age was 44 years (interquartile range: 35-54), and 63.4% were females. Of all the patients, 130 (85.0%) were aged <65 years and 23 (15.0%) were aged ≥65 years. The overall response rate was 83.7%, with no significant difference between age groups (P = 0.965). Geriatric patients had more comorbidities (P < 0.001), polypharmacy (P = 0.004), and malignancy (P = 0.045). Basophil (P = 0.013) and eosinophil (P = 0.024) counts were lower in the elderly. Among non-responders, autoimmune disease (P = 0.004), elevated anti-thyroglobulin (P = 0.016), and lower baseline UCT scores (P = 0.009) were more frequent. No serious adverse events occurred.

CONCLUSIONS

Omalizumab is effective and safe for CU even in older adults. Age, comorbidities, and polypharmacy do not affect treatment response, while autoimmunity and baseline disease activity may predict outcomes.