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Specialist dermatology + allergy · UK

Omalizumab (Xolair) for chronic urticaria and angioedema, delivered by a consultant service.

A monthly anti-IgE injection for the chronic hives and swellings that antihistamines cannot control. NHS-funded per NICE TA339 if you qualify - private if you don’t, or if you don’t want to wait.

See indicative pricing
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Indicative pricing

What omalizumab costs privately in the UK.

The drug is the dominant cost. NHS funding is available if you meet NICE TA339 criteria - we tell you which route is faster and cheaper.

In short

£1,000–£1,600, given every four weeks.

Item Indicative range
Omalizumab 300mg injection (private) £1,000–£1,600
Omalizumab 150mg injection (lower dose) £600–£950
First-dose 2-hour observation loading £150–£300
Dermatology or allergy consultation £250–£450
Baseline bloods (FBC, TFT, autoimmune) £180–£320
Home self-administration training £200–£400

Prices vary by clinic and by whether the first-dose observation is bundled.

The problem

The right criteria, the right specialist, the right monitoring.

Omalizumab is transformative for the right patient - but it is a specialist biologic, not a walk-in prescription. We make sure the criteria, the workup and the review structure are all right before you commit.

  • Not sure you qualify?

    A documented UAS7 ≥28 on high-dose antihistamines is the gateway to NICE TA339 funding.

  • Worried about long-term steroids?

    Repeated prednisolone courses are a red flag, not a plan. Omalizumab is the intended alternative.

  • Want a real response review?

    A named consultant, UAS7 every cycle, and a real 12- and 24-week decision - not a repeat prescription forever.

When it helps

When omalizumab is the right step.

The presentations that fit NICE TA339, the related indications delivered by other specialties, and the one red flag that means A&E rather than an appointment.

  • Chronic spontaneous urticaria (CSU)

    Hives on most days for six weeks or more, no identifiable trigger, still symptomatic on high-dose non-sedating H1 antihistamines.

  • Recurrent angioedema with hives

    Deep swellings of lips, eyelids or hands alongside urticaria - the mast-cell driven pattern omalizumab is designed for.

  • UAS7 ≥28 despite maximum antihistamines

    The NICE TA339 threshold. Loratadine, cetirizine or fexofenadine up-titrated to four times the standard dose, still not enough.

  • Steroid-dependent urticaria

    Repeated short courses of oral prednisolone to keep hives under control - a signal the current plan is not sustainable.

  • Chronic rhinosinusitis with nasal polyps

    A separate NICE indication (TA1039, 2024). Managed by respiratory or ENT rather than this page, but the same drug.

  • Severe allergic asthma

    The original NICE indication (TA278).

  • Idiopathic angioedema (off-label)

    Recurrent angioedema without urticaria and without a C1-inhibitor cause. Some specialists use omalizumab off-label when standard treatment fails.

  • Red flag: throat swelling or stridor

    Angioedema affecting the tongue, throat or voice, or any difficulty breathing, is a same-day A&E problem - not a clinic booking.

Treatment options

Omalizumab is not the only option.

The dose variants, the newer biologic alternative, and the older systemic agents that still have a role.

  • Omalizumab 300mg every 4 weeks

    The standard CSU dose per NICE TA339. Two 150mg subcutaneous injections, once a month, delivered by a specialist service.

  • Omalizumab 150mg every 4 weeks

    A lower-dose option. Less effective than 300mg for CSU in the ASTERIA trials, occasionally used for milder disease or dose reduction.

  • First-dose observation (2 hours)

    Current UK practice observes the first injection for two hours for anaphylaxis. Subsequent doses are observed for 30 minutes.

  • Home self-administration

    After training and a stable response, some services allow patients to self-inject at home - check with your specialist team.

  • Dupilumab (Dupixent) - alternative

    NICE TA974 (2024) approved dupilumab for CSU as an alternative biologic. Anti-IL-4/13 rather than anti-IgE. Different mechanism, different profile.

  • Ciclosporin - alternative

    A long-standing off-label option for severe antihistamine-refractory CSU. Effective, but with blood pressure and renal monitoring.

  • Montelukast add-on

    A leukotriene receptor antagonist used off-label as add-on for CSU. Modest evidence - usually tried before biologics.

  • BTK inhibitors (remibrutinib) - trial

    A newer oral option in phase 3 trials for CSU. Not yet approved in the UK. Ask if trial access is appropriate.

Safety and side effects

What to expect - honestly.

Omalizumab has a decade of post-marketing data in urticaria. The important things to plan are the first-dose observation, the response window, and knowing what is normal after an injection.

  • Injection-site reactions are common

    Redness, itch or a lump at the injection site in more than one in ten patients. Usually settles within a day or two.

  • Headache and upper respiratory infections

    The two other common side effects. Usually mild, usually settle, rarely a reason to stop treatment.

  • Hypersensitivity and anaphylaxis are rare

    Serious allergic reactions are uncommon but real - hence the first-dose two-hour observation and 30 minutes for subsequent doses.

  • Thromboembolism signal - small and debated

    A signal for venous thromboembolism appeared in some analyses; it is small and clinically debated. Your specialist will consider your personal risk.

  • Malignancy signal - small and debated

    A small malignancy signal was raised in early data. Longer-term follow-up has been reassuring but the discussion belongs in your consultation.

  • Response takes weeks, not hours

    Some patients respond after the first injection; most need two or three cycles. Give it a fair 12-week trial before judging.

  • Long-term commitment, with review points

    Six months minimum for a genuine trial. Beyond that: continue, take a break, or switch - a decision at every six-month review, not a default.

  • Pregnancy and breastfeeding

    Existing data are broadly reassuring but not definitive. A specialist decision, not a blanket rule.

  • Red flags

    Widespread rash, breathing difficulty, throat swelling, fainting or severe abdominal pain after an injection are 999 problems, not clinic ones.

Reading your treatment note

Your injection record in four parts. Read the last one first.

Whichever service delivers the injection, the note your specialist sends keeps to the same shape.

A UK consultant dermatologist reviewing a patient’s biologic treatment notes

A quiet reminder

Specialist language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Indication and dose confirmed

    CSU with UAS7 ≥28, antihistamines up-titrated, dose (usually 300mg), and NICE TA339 or private-pay basis explicitly stated.

  2. 02 Technique

    Injection details and observation

    Site, batch number, whether first-dose 2-hour observation or 30-minute follow-on, any reaction recorded.

  3. 03 Findings

    UAS7 trend and side effects

    This cycle’s UAS7 alongside baseline and previous cycles. Any injection-site reaction, headache or infection noted with severity.

  4. 04 Impression

    Response category and next review

    Read this first: clear responder, partial, or non-responder - and whether the next dose, a break, dose reduction, or switch is planned.

Recognised by major UK insurers

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Cover for biologics varies by insurer. Most fund omalizumab when NICE TA339 criteria are met and prior antihistamine treatment is documented.

Frequently asked

Everything we get asked about omalizumab for urticaria.

Quick answers on eligibility, cost, response, alternatives and how long you might stay on treatment.

  • What is omalizumab and how does it work?

    Omalizumab (brand name Xolair) is a humanised monoclonal antibody. It binds to free IgE in the bloodstream, stopping IgE from activating mast cells and basophils. In chronic spontaneous urticaria this reduces the release of histamine and other mediators that drive hives and angioedema.

  • Who is omalizumab for in urticaria?

    Per NICE TA339 (2015), adults and adolescents aged 12 and over with severe chronic spontaneous urticaria - hives for six weeks or more with no identified trigger - whose disease remains uncontrolled on high-dose non-sedating H1 antihistamines (up to four times the standard dose, for example loratadine 40mg daily), with a documented UAS7 of 28 or more.

  • How is it given, and how often?

    A subcutaneous injection of 300mg every four weeks, delivered at a specialist dermatology or allergy service. Some services offer a lower 150mg dose. After a stable response, home self-administration may be possible.

  • How quickly does omalizumab work for urticaria?

    Some patients notice a difference within days of the first injection. Most see meaningful improvement by weeks two to eight. A fair trial is 12 weeks - that is when your specialist assesses whether you are a responder, partial responder or non-responder.

  • How much does omalizumab cost privately in the UK?

    Roughly £1,000–£1,600 per 300mg injection privately - the drug itself is the dominant cost. A lower 150mg dose is around £600–£950. NHS funding is available at specialist services if you meet the NICE TA339 criteria.

  • Is it available on the NHS?

    Yes. NICE TA339 recommends omalizumab as an option for severe CSU in adults and adolescents 12+ where high-dose antihistamines have failed and UAS7 is 28 or more. It is delivered by NHS specialist dermatology or allergy services - not by GPs.

  • What are the alternatives if omalizumab does not work?

    Dupilumab (Dupixent) was recommended by NICE (TA974, 2024) as a newer biologic option for CSU. Ciclosporin is a long-standing off-label option. Short courses of oral corticosteroids are used sparingly for flares - not for the long term. BTK inhibitors like remibrutinib are in trials.

  • How long will I need to stay on it?

    A minimum of 24 weeks to judge response. Beyond that, some patients stay on treatment for years; others take a break and restart if hives return. Continuation is reviewed every six months - it should not be an open-ended prescription.

  • What are the main side effects?

    Common (more than one in ten): injection-site reactions, headache, upper respiratory infections. Uncommon: hypersensitivity reactions and, rarely, anaphylaxis - which is why the first injection is observed for two hours. Small signals for thromboembolism and malignancy exist but remain debated.

  • When should I see a GP or A&E urgently?

    Angioedema affecting the tongue, throat or voice, any difficulty breathing or swallowing, fainting after an injection, or a widespread new rash with fever are all reasons to seek same-day medical help.

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