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Unlocking Omalizumab: Can Blood Tests Predict Urticaria Relief?

Lena Kashyap in Health & Wellness November 2025 • 4 min read.

"New research explores how simple blood markers could help predict who will benefit from omalizumab treatment for chronic hives."

Chronic spontaneous urticaria (CSU), characterized by bothersome hives and/or angioedema lasting six weeks or longer, affects approximately 1-2% of the population. Antihistamines are typically the first line of treatment, but many individuals continue to experience symptoms despite high doses. For those individuals, omalizumab, a targeted therapy, offers hope.

Omalizumab, is a monoclonal anti-immunoglobulin E (IgE) antibody, has emerged as a valuable treatment option for antihistamine-resistant CSU. This medication works by binding to IgE, reducing its ability to trigger the allergic cascade that leads to hives. While omalizumab is effective for many, predicting who will respond best remains a challenge.

A new study published in the Turkish Journal of Medical Sciences investigates the potential of using simple blood tests—specifically, platelet parameters and the neutrophil-lymphocyte ratio (NLR)—to predict the effectiveness of omalizumab in patients with severe CSU. This research offers a promising avenue for personalizing treatment and improving outcomes for individuals struggling with chronic hives.

What Blood Markers Can Tell Us About Omalizumab Response?

The study, conducted at a health sciences center in Turkey, involved 143 patients with CSU and 132 healthy controls. Researchers analyzed various blood parameters, including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), before, during, and after omalizumab treatment. Patients were classified as responders or non-responders based on their urticaria activity scores (UAS) after 12 weeks of treatment.

Here's a breakdown of what the study revealed:

Baseline Differences: CSU patients exhibited higher baseline MPV and lower baseline PDW values compared to healthy controls.
Treatment-Related Changes: Omalizumab treatment led to statistically significant increases in MPV, MPV/platelet count, and PDW, as well as a significant decrease in NLR.
Predictive Markers: A lower increase in MPV was observed in non-responders, and non-responders had lower PDW values than responders at week 4 of treatment.

These findings suggest that changes in platelet parameters and NLR during omalizumab treatment may reflect the medication's impact on platelet activation and inflammation. The ability to differentiate responders from non-responders based on these markers could have important clinical implications.

Personalizing Urticaria Treatment: A Step Forward

This study offers valuable insights into the potential of using blood markers to predict omalizumab response in patients with severe CSU. While further research is needed to validate these findings and explore the underlying mechanisms, the results suggest that MPV and PDW could serve as inexpensive and readily available biomarkers for personalizing treatment decisions. By identifying patients who are more likely to benefit from omalizumab, clinicians can optimize treatment strategies and improve outcomes for individuals living with chronic hives.

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This article is based on research published under:

DOI-LINK: 10.3906/sag-1803-87, Alternate LINK

Title: Evaluation Of Platelet Parameters And Neutrophil/Lymphocyte Ratio During Omalizumab Treatment In Patients With Severe Chronic Spontaneous Urticaria

Subject: General Medicine

Journal: TURKISH JOURNAL OF MEDICAL SCIENCES

Publisher: The Scientific and Technological Research Council of Turkey (TUBITAK-ULAKBIM) - DIGITAL COMMONS JOURNALS

Authors: Ragıp Ertaş, Kemal Özyurt, Çiğdem Karakükçü, Muhammet Reşat Akkuş, Emin Özlü, Atıl Avci, Mustafa Atasoy

Published: 2018-12-12

Everything You Need To Know

What is Omalizumab, and how does it help with chronic hives?

Omalizumab is a monoclonal anti-immunoglobulin E (IgE) antibody used to treat chronic spontaneous urticaria (CSU), a condition characterized by persistent hives and/or angioedema. It works by binding to IgE, which reduces the allergic cascade that triggers hives, offering relief to those who don't respond well to antihistamines.

Which blood tests were analyzed to predict Omalizumab effectiveness?

The study analyzed several blood parameters, including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). These markers were measured before, during, and after Omalizumab treatment to assess their predictive value for treatment response in patients with CSU.

How can MPV and PDW help predict if Omalizumab will work for a patient?

The study found that patients with CSU had different baseline MPV and PDW values compared to healthy controls. Moreover, changes in MPV and PDW during Omalizumab treatment could predict response. Specifically, a lower increase in MPV and lower PDW values at week 4 of treatment were observed in non-responders, suggesting these markers can indicate treatment effectiveness.

Why is personalizing treatment with Omalizumab important for CSU patients?

Personalizing treatment with Omalizumab is crucial because, while the medication is effective for many, not all patients respond equally. By using blood markers like MPV and PDW to predict response, clinicians can identify patients who are most likely to benefit. This personalized approach optimizes treatment strategies, potentially avoiding unnecessary treatments and improving outcomes for individuals struggling with chronic hives.

What are the implications of the study's findings on using NLR in relation to Omalizumab treatment for CSU?

The study revealed that Omalizumab treatment led to a significant decrease in the neutrophil-lymphocyte ratio (NLR). The NLR reflects the balance between neutrophils and lymphocytes, and its reduction suggests that Omalizumab has an anti-inflammatory effect. Although NLR was not a direct predictor like MPV and PDW, the change in NLR indicates that Omalizumab affects the underlying inflammatory processes involved in CSU. This offers another perspective into the drug's mechanism of action.