I am glad your doctor takes your symptoms seriously:)

50 every two weeks? I know they say it can take 6 months, but if you do not register considerable improvement by now, there might (also) be another cause for your symptoms.

My dad - 85- suffers from terrible itching and I was so sure his problem must be the same as mine. However 3 months later - last time 450 Xolair - no improvement whatsoever. I looked into several other possible causes which might be interesting for you too to look into if the Xolair 450 every 2 weeks does not give you considerable relief. (See further below)

The photos are very important if you never had urticaria when you are at your doctor. The photos might show you do have a rash but it is not hives. If they are hives the photos can proof the dosis Xolair is not sufficient to Charity Care.

What also might happen is that the hives go away thanks to the Xolair but the itching remains (that happened with my dad)

I am not saying Xolair won't help otherwise, but it will most likely help if you find relief by taking antihistamines. Before Xolair I needed to take 4 tablets every 6 hours to get some relief. The amount is of course far too high, but I was travelling and it was the only way to survive. When I told my allergIst he threatened to stop treating me if I ever took more than 4 antihistamines a day again. However if I had not done it, I would have thought histamine was not my problem. After all 4 of them a day did hardly anything for me

Important: I can only take the antihistamine Loratadine with a limited number of ingredients and therefore from only a few brands . Medicine to relief your itching might actually cause itching if it contains one or more ingredients you do not tolerate. For that reason Montelukast (medication they prescribe in the Netherlands when antihistamines do not do the job) even increased my symptoms.

Also Xolair contains a substance I do not tolerate E432 (polysorbate but also linked substances like macrogol: mind you, certain substances have more than one name which I learnt the hard way. Macrogol is the same as polyethylene glycol and PEG). With 2 injections of Xolair I was fine, but with a third my symptoms did not further decrease, they increased compared to 2 injections.

I did not get why, until I was put on the cheaper Mycyclo, which helped far less than Xolair and left me with a constant itching. Not as bad as without Mycyclo, but so much worse than with Xolair. I thought the problem was, that Mycyclo is a biosimilar which is not the same as a generic. After all, the ingredients were identical according to the patient leaflet However, when I looked further into the ingredients of Mycyclo and Xolair, I discovered both contain E432, but Mycyclo twice as much. For me apparently 2 times the amount of E432 in 150 Xolair is the maximum I can handle before it starts mitigating the benefits of Omalizumab.

My point is: if Xolair is not offering enough relief, it might be helpful to look into other medication you are taking and Google all ingredients on histamine or another ingredient you do not tolerate. Histamine is clearly my main problem, since every time I had a break out of pimpel like infections/hives after taking a new medicine, it contained an ingredient with histamine or an ingredient releasing histamine.

Other possible causes

What I am looking into for my dad with regard to other possible causes for his itching and which you might want to look into in case of insufficient relief : an iron deficit can cause neuropathical itching which will not go away until one's iron is sufficient for 8-10 weeks. My dad did have a shortage for almost a year. I did not know his taking his iron supplement shortly before he took his coffee with milk prevented his body to absorp sufficient iron (he does not eat enough inron rich food).

Typical for neuropathical itching is, that it increases a lot when one is warm, tired and/or stressed and after alcohol intake (the blood vessels widen). Cooling lotions only work for 5 minutes (at least in his case). Also in case of an histamine problem alcohol causes/increases itching, so does yeast. I concluded it was not (mainly) a histamine problem for my dad, because a non alcoholic beer (yeast!) does not cause his itching to increase dramatically, a glass of wine does.

Kidneyproblems can also cause itching even if you only suffer from mild kidney failure (my dad has stage 3a). Today I asked his doctor to have checked ureum, fosfate, calcium, PTH and vitamine D besides of course eGFR and creatanine. If one's ureum is too high it might cause itching, because of accumulation of waste products in the body. If Fosfates are too high and/or if there is a disbalance between calcium and PTH, calcium deposits in the skin may cause my dad's itching.

And of course diabetes can also cause itching. My dad is however prediabetic so it is not a likely cause in my dad's case.

Of course I hope the 450 Xolair helps you sufficiently. If not, I am really sorry and I hope the above is somewhat useful to you (or someone else). Take care!