Should a patient with breakthrough urticaria, on maximal dosing of second generation H1 antihistamines with elevated CRP and anti-TPO antibodies, be treated with omalizumab to protect the thyroid from autoantibodies and improve urticaria control?

This patient likely has chronic autoimmune (Type IIB) urticaria. Would obtain a CU index. It is likely based on data that OMA would be less effective at the currently approved doses. There is data that increasing the dose or frequency of administration of OMA may be effective in those patients with CAU not responsive to OMA 300mg every 4 weeks, but getting this approved requires prior authorization and can be time-consuming and less impactful than switching to an alternative agent. These biomarkers don't appear to be relevant in the newly approved therapies, Dupi and Remi, and in fact, there is emerging data that Remi may be very effective in the CAU phenotype. In summary, we have not completely reached the pinnacle of personalized medicine...