2018, Number 2
Alerg Asma Inmunol Pediatr 2018; 27 (2)
Anaphylaxis to omalizumab: what to do?
Martínez VLE, Rodríguez GM, Sorcia RG, Villaverde RR, Mendoza HD
Full text
Language: Spanish
References: 15
Page: 60-66
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ABSTRACT
Background: Omalizumab is a recombinant humanized monoclonal antibody anti-IgE antibody. It has been effective for the treatment of certain allergic diseases such as moderate and severe allergic asthma and chronic spontaneous urticaria. Patients present clinical benefit with few or no adverse effects. Although its high security profile as a biological agent, omalizumab administration can cause serious or life-threatening allergic reactions such as anaphylaxis. Drug adverse reactions may lead to the use of premedication so that the drug does not has to be discontinued if there is not an available alternative for the treatment of a particular disease. Vernal keratoconjunctivitis is a rare allergic ocular disease. It’s patophysiology involves chronic inflammation and the formation of papilae. It can be either IgE-mediated (type I hypersensitivity reaction with a positive sensitization profile for environmental allergens) and cellular mediated (type IV hypersensitivity reaction) have been involved. The diagnosis is made out of clinical manifestations. First line treatment is preventive measures and pharmacotherapy. Immunotherapy has a role in particular cases as well as novel therapies with biological agents such as omalizumab. Clinical outcome varies due to the persistence and progression of chronic inflammation and secuelae. Clinical case: We present the case of a male teenager (14 years old). He was accepted at the Outdoor Allergy Clinic Unit within National Institute of Pediatrics as he presented a wide spectrum of allergic diseases (vernal keratoconjunctivitis, allergic rhinitis, asthma, atopic dermatitis, food allergy) and had not responded well to first and second line pharmacotherapy. Due to various allergic comorbidities and high levels of IgE, he was proposed for administration of omalizumab. After the administration of the first subcutaneous dose, he presented anaphylaxis (respiratory and skin symptoms) and was treated at the Emergency Department. A two way approach was considered after the severe allergic reaction: either discontinue omalizumab or continue its administration with premedication or desensitization with close follow up. We chose to continue omalizumab as it was considered the best therapeutic option. The patient was given premedication with systemic H2 antihistaminic and systemic steroid and was given subcutaneous administration of omalizumab every two weeks. He has currently received eight doses four months without adverse effects. Very good clinical status and a much better quality of life have been achieved. Conclusions: Use of omalizumab should be considered in severe allergic diseases or when there is comorbidity with different allergic diseases as well as poor quality of life and bad response to first line treatment. Although infrequent, severe allergic reactions must be considered with the use of omalizumab, and if these happen drug removal should be considered whether there is or not any treatment alternative or considering pros and cons: in this particular case we considered to do not discontinue omalizumab use and the patient was premedicated and has successfully received the first e doses. We also demonstrate a clinical benefit for the use of omalizumab in vernal keratoconjunctivitis. Every case must be considered individual and it is extremely important to consider the impact on quality of life.REFERENCES