Depression scores change significantly after omalizumab treatment in patients with chronic spontaneous urticaria

Background: Chronic spontaneous urticaria (CSU) is frequently associated with psychiatric comorbidities. Objective: We aimed to determine if depressive symptoms were present in CSU patients who received omalizumab and if depression scores got better with omalizumab treatment and whether the presence of depressive symptoms impaired treatment responses. Methods: CSU patients who received at least three injections of omalizumab were included in the study. Changes in Urticaria Activity Score (UAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q²oL), Beck Depression Inventory (Beck-D) and Urticaria Control Test (UCT) scores were compared before and after treatment. Results: From 49 patients, 20 (40.8%) had depressive symptoms at baseline. After treatment, UAS7, CU-Q²oL, Beck-D scores decreased and UCT-scores increased significantly (p < 0.001, for all). UCT scores were lower at baseline and at 3^rd month following treatment in patients with depressive symptoms compared to patients without (baseline median (interquartile range-IQR) 2.5 (1-5) vs 5 (2.5-6.5); p = 0.04 and 3^rd month 12 (9-13) vs 14 (12-16); p = 0.006, respectively). Omalizumab non-responders had higher baseline Beck-D-scores [18.5 (15.2-22) vs 12 (6-22.5); p = 0.031]. The number of omalizumab non-responders were significantly higher among patients with depressive symptoms compared to patients without. (40% vs 13.8%; p = 0.048). Only 6 patients scored as having depressive symptoms after treatment; of these 6 patients only one was an omalizumab responder. Conclusion: Omalizumab not only provides symptom control for urticaria but also improves psychological conditions of the patients. Coexistent psychiatric comorbidities should be taken into account in CSU patients since these conditions might impair treatment response.