For background: I actually went on Xolair to treat eczema, which is an off-label use, but my IgE antibodies were high enough thanks to 5000 environmental allergies (mold, pollen, dust, more dust...) that they got my insurance to approve it under standard criteria. I also have asthma, which is one of the things it's approved to treat, so that might be a good pathway to approval and a symptom you can reduce.

Prior to Xolair, my skin used to get so fucked-up and dry that my eyelids would crack and bleed and weep some kind of liquid. On more than one occasion I had strangers ask me if I had lupus because it looked like I had the characteristic butterfly rash. And I'd get miserable allergy symptoms whenever it was windy (which is often, since I live in a valley) or I was around environmental triggers (which is also often, since I'm allergic to pretty much everything that grows in this biome).

After being on Xolair, I have pretty much zero problems with eczema (although the TNF inhibitors I started taking for general autoimmune shit share some of the credit there) and my allergies are all but gone. It's wild. I actually forgot about how shitty I used to feel in windy weather until I looked outside, saw that it's windy today, and was like "Oh yeah, that used to mess me up...."

Dust doesn't fuck me up the way it used to; when I vacuum under the bed, I can feel something happening in my skin, like the sensation of breaking out in the mildest of sweats, but otherwise it doesn't bother me. My pollen tolerance is also significantly better—we actually started growing some pepper plants indoors, and it's the same thing where I can almost feel the pollen coming off them when I get really close, but I have to be within two feet to notice and it's not, like, unpleasant. More like a sixth sense.

My asthma might be a little better too, but it's hard to say. I've been able to exercise more easily than I ever could when I was a kid, although I was a pretty wimpy kid in the first place, lol.

So, long story short: I'd definitely recommend Xolair! Other than the requisite insurance hassle and having to spend a few hours every month getting my shots, zero complaints here. One of the best success stories I've heard is that my allergist had a patient who was a professional archeologist with terrible allergies, but after going on Xolair they were able to go on digs without issue.

Also, regarding oral antihistamines, have you tried any Rx drugs like hydroxyzine? My allergist put me on 35mg of that nightly and it knocks down anything the Xolair wasn't already doing. My partner also takes it and it's helped their significantly-less-severe allergies as well, plus zafirlukast for polyp-spurred inflammation.

I tried allergy immunotherapy (aka. "allergy shots") but it was very rough and it aggravated blood pressure issues and gave me joint pains, so I opted to discontinue after the second attempt.

On hydroxyzine, I've taken cetirizine (2nd gen, metabolite of hydroxyzine) in the past. 1st gen antihistamines usually knock me out. I'm now on Fexofenadine (Allegra, Telfast) which is mostly covered by my insurance and works pretty good still.

One crazy thing for eczema sufferers, if you get bad eczema on neck and arms during summer don't assume you have a heat rash, patch test your sun screen. I now use zinc based sun screen after a dermatologist patch test identified I was allergic too Oxybenzone's. Never has a clue and I live in a country with very high UV levels.