Restoration of aspirin tolerance following omalizumab treatment in a patient with chronic spontaneous urticaria.

Up to 30% of cases of chronic spontaneous urticaria (CSU) are exacerbated by COX-1 inhibiting nonsteroidal anti-inflammatory drugs (NSAID); this clinical picture is termed NECD (NSAID-exacerbated cutaneous disease). On the other hand, multiple NSAID hypersensitivity may occur in the absence of an underlying CSU also, a situation that is termed NIUA (NSAID-induced urticaria / angioedema). The present study reports a case of multiple NSAID hypersensitivity that occurred in a man much before he developed severe CSU. Omalizumab treatment eventually induced a remission of the cutaneous disease which was associated with aspirin tolerance, as assessed by open oral challenge with the drug. Altogether, this case suggests that it might be worth to investigate tolerance to aspirin or other strong COX-1 inhibitors NECD patients showing a complete response to omalizumab, and maybe also the effects of omalizumab in NIUA patients as well.