Omalizumab’s role in the treatment of steroid dependent malignant idiopathic anaphylaxis

Abstract

If an anaphylaxis episode is not caused by an identifiable trigger, it is defined as idiopathic anaphylaxis. Although it is rarely observed, idiopathic anaphylaxis is clinically significant because of its morbidity and fatality risk. No effective treatment has been demonstrated to date. We report a girl aged 16 years who had had malignant idiopathic anaphylaxis since the age of 12 years who was treated successfully with omalizumab. Although she avoided allergic trigger foods such as tomato and seafood, she used to have these attacks twice a week. Attacks were averted by taking 60 mg prednisone. When prednisone was tapered down to 5 mg on every alternate day, the episodes recurred. Later, attacks could not be controlled on <30 mg of prednisone daily. After being steroid-dependent for 4 years, subcutaneous omalizumab 225 mg every two weeks was started. Under omalizumab therapy, the attacks disappeared and prednisone was discontinued. (Turk Pediatri Ars 2017; 52: 105-7)

Idiopathic anaphylaxis yardstick

“…Several case reports support the benefit of omalizumab for the prevention of IA, [136][137][138][139] as well as the prevention of anaphylaxis associated with Hymenoptera allergy immunotherapy, mastocytosis, and MCAS. [140][141][142][143][144][145] Omalizumab also has been shown in randomized double-blind placebo-controlled and open-label trials to be efficacious in decreasing anaphylaxis associated with oral immunotherapy to food allergens.…”

“…Efficacy of omalizumab for the prevention of IA episodes in children has been published in case reports. 136,139 Dosing for omalizumab should be based on the packet insert, or for patients with low IgE values, using the dosing schedule recommended for chronic idiopathic urticaria. Cytoreductive therapy is in general not recommended in the pediatric population.…”

Idiopathic anaphylaxis

“…Omalizumab, an anti‐IgE monoclonal antibody, blocking IgE binding to MCs and basophils, is currently used for the treatment of severe allergic asthma and chronic spontaneous urticaria. It has been used effectively in few young patients with resistant IA at 300‐375 mg, every 2‐4 weeks . Rituximab, an anti‐CD20 monoclonal antibody, is another novel agent warranting further exploration.…”

“…It has been used effectively in few young patients with resistant IA at 300-375 mg, every 2-4 weeks. 14,65,66 Rituximab, an anti-CD20 monoclonal antibody, is another novel agent warranting further exploration. Borzutzky et al 62…”

Idiopathic anaphylaxis: Diagnosis and Treatment.

“…Malign idiopatik anafilakside, steroid tedavisi azaltılamaz veya steroid tedavisi kullanılmasına rağmen ataklar gözlenir. Bu hastalarda rituksimab (anti-CD20) ve omalizumab (anti-Ig E) tedavisi denenebilmektedir [57][58][59] . Bunların optimum dozu ve zamanlaması günümüzde bilinmemektedir.…”