The monoclonal anti-IgE antibody omalizumab is currently approved for the treatment of severe asthma. Randomized controlled trials for the indication atopic eczema have not yet been performed. This paper summarizes the current evidence on the effectiveness of omalizumab in atopic eczema. Using a systematic electronic search strategy, we identified three case series. These suggest that a subgroup of patients with extrinsic atopic eczema but only moderately elevated IgE levels might benefit most from omalizumab treatment. A randomized controlled trial should be performed to clarify the potential benefit of omalizumab for patients with atopic eczema. Additionally, such a study might help us to better understand the role of IgE in the pathogenesis of atopic eczema.