Brief Answer:
It may be useful in refractory chronic urticaria.

Detailed Answer:
Hello and welcome,

I know that chronic autoimmune urticaria is extremely aggravating and can be life limiting and debilitating.

Be sure to have thyroid levels and thyroid autoantibodies checked and also a blood tryptase level for possible mastocytosis. And a complete blood count to check for eosinophilia.

Xolair (omalizumab) is a monoclonal antibody that goes after your own IgE (immunoglobulin E) antibodies, which can be involved in the allergic response. There is some evidence that it can be helpful in chronic urticaria. But it is not a first line choice. It may be tried when maximal doses of H1 antihistamines and other standard medications have been tried without success. This means, if using cetirizine (Zyrtec), that you are using at least 4 pills of it a day (i.e. 4x the standard dose).

Doxepin is a very good antihistamine for itching but can cause a lot of sedation. If using this, maximal doses of this too, should be tried before moving on to Xolair.

It looks like you have already tried a variety of meds for chronic urticaria, and I'll assume you have maxed out the dose as recommended. Sometimes allergists/immunologists will also add an H2 blocker such as Zantac (ranitidine) as some of the histamine receptors in the skin are the H2 type. But doses of more than 300 mg of ranitidine are not more effective.

If all of this has been tried, then you and your allergist or rheumatologist might consider Xolair.

Here is a PDF of information from the XXXXXXX Academy of Allergy, Asthma & Immunology (AAAAI) on treating chronic urticaria (CU). Please see page 1276 - the last paragraph talks about omalizumab (Xolair). http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Urticaria-2014.pdf

Also on that page, please see the figure which shows the recommended step wise treatment for chronic urticaria.

I hope this helps and I do hope you are able to get relief from the urticaria soon!

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