Omalizumab Treatment for Prevention of Anaphylaxis

Abstract

Opinion StatementRCTs utilizing a specific treatment followed by meta-analysis of multiple RCTs for the specific treatment are the cornerstone of evidence-based medicine. This approach provides key insights into the average response of a therapeutic agent in the selected patient population for the target disease. Generally speaking, a developing trend is more investigations of medical therapies aiming to describe individual patient variability; further, such investigations typically aim to discover and subsequently understand this variability based on biomarkers or even disease-specific genetic polymorphisms among patients. This research returns us to the examination room where we treat individual patients. Given the complexity of idiopathic anaphylaxis and the currently available literature, we believe the time is now to initiate treatment trials of omalizumab in patients not well controlled with prior standard therapy. The use of prolonged systemic steroids should be avoided in favor of a trial of omalizumab. We do not intend to minimize the importance of double-blind placebo-controlled trials. However, based on the full spectrum of current evidence, we do not want to be blinded at the present time by the absence of a published RCT specific to idiopathic anaphylaxis.