{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:32:04Z","timestamp":1793381524984,"version":"4.5.0"},"reference-count":11,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Arch Allergy Immunol"],"abstract":"<jats:p>Introduction: Omalizumab is highly effective in H1-antihistamine refractory chronic spontaneous urticaria (CSU), but disease relapse frequently follows treatment discontinuation. Whether gradual de-escalation reduces recurrence rates compared with abrupt cessation remains controversial. Methods: Following PRISMA 2020 guidelines, PubMed, EMBASE, Web of Science, and Cochrane Library were searched through April 2026 for randomized controlled trials and observational cohorts evaluating omalizumab withdrawal in controlled CSU. Random-effects proportion meta-analysis (DerSimonian-Laird logit transformation) determined pooled relapse rates. Subgroup differences were tested via Cochran\u2019s Qb statistic. Results: Eleven primary studies yielding 13 independent study arms (evaluable N = 1,382) met inclusion criteria (total reviewed population N = 5,130). The overall pooled post-discontinuation relapse rate was 39.5% (95% CI: 30.1%\u201349.7%; I2 = 91.5%). Gradual de-escalation achieved a significantly lower pooled relapse rate compared with abrupt discontinuation (31.2% [95% CI: 20.3%\u201344.7%] vs. 48.9% [95% CI: 37.0%\u201361.0%], Qb = 8.12, df = 1, p = 0.004). Notably, dose reduction (150 mg every 4 weeks) yielded the lowest pooled relapse rate at 23.3% (95% CI: 9.2%\u201347.6%; I2 = 50.4%), outperforming interval extension (33.6%). Concomitant angioedema was an independent risk factor for relapse (multivariate OR = 2.399, p = 0.004), whereas gradual de-escalation was protective (multivariate OR = 0.373, p = 0.005). Conclusion: Gradual omalizumab de-escalation significantly reduces post-discontinuation relapse rates compared with abrupt cessation in controlled CSU. Stepping down dose density to 150 mg every 4 weeks provides superior remission stability compared with interval extension or abrupt stopping, serving as a primary clinical recommendation for treatment optimization.<\/jats:p>","DOI":"10.1159\/iaa\/adfag017","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:48:14Z","timestamp":1786798094000},"page":"1-1","source":"Crossref","is-referenced-by-count":0,"title":["Relapse Rates, Time-to-Flare, and Biomarker Predictors following Omalizumab Gradual De-Escalation versus Abrupt Discontinuation in Controlled Chronic Spontaneous Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohorts"],"prefix":"10.1159","author":[{"given":"Muhammed \u015eah","family":"Do\u011fan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sezgin","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruhat","family":"Tun\u00e7","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15090"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215372"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.05.013"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2014.306"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.08.050"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1111\/all.16243"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2015.12.1342"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1080\/14712598.2018.1438406"}],"container-title":["International Archives of Allergy and Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/iaa\/adfag017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:01:44Z","timestamp":1793379704000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/iaa\/adfag017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":11,"URL":"https:\/\/doi.org\/10.1159\/iaa\/adfag017","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33274632","asserted-by":"subject"}]},"ISSN":["1018-2438","1423-0097"],"issn-type":[{"value":"1018-2438","type":"print"},{"value":"1423-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}