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Omalizumab: A Previously Unreported Side Effect of Therapy
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A5575 - Omalizumab: A Previously Unreported Side Effect of Therapy
Author Block: L. Farhat1, D. Rastogi1, L. Bernstein2, A. Bidiwala1; 1Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States, 2Allergy and Immunology, The Children's Hospital at Montefiore, Bronx, NY, United States.
Introduction: The allergic triad of asthma, allergic rhinitis, and atopic dermatitis is commonly seen in both children and adults. Many of these patients have concurrent elevated levels of IgE. Anti-IgE [omalizumab] has been used with success for the treatment of severe asthma and allergic rhinitis, however with variable success when used for atopic dermatitis. We report an unusual case of a young man whose treatment with omalizumab severely exacerbated his atopic dermatitis.
Case description: 15 year old male with history of atopic dermatitis, moderate to severe persistent asthma, and allergic rhinoconjunctivitis presented at our pulmonology clinic. He had a history of significant sensitization to multiple aeroallergens as well as very elevated IgE levels. Despite being on maximal pharmacotherapy, he continued to have allergic rhinoconjunctivitis and asthma symptoms. The decision was then made to start him on omalizumab. A significant improvement was noted in his allergic rhinoconjunctivitis and asthma symptoms several weeks after initiating therapy. However, his eczema became severe despite an unchanged external environment. It was also noted that his eczema began worsening specifically in the evening after receiving omalizumab injections during the day. Omalizumab dosing was then spaced to every 4 weeks to minimize these exacerbations. Between doses his eczema would improve, only to flare again after receiving omalizumab. Considerable relief of symptoms was achieved after the patient was evaluated by dermatology and started pre-treatment with topical medications on scheduled omalizumab injection days.
Discussion: To our knowledge, severe exacerbation of atopic dermatitis has not been reported previously as a side effect of omalizumab therapy. The most common reported adverse effects are injection site reactions. More rarely, anaphylaxis has been reported to occur beyond one year after initiation of therapy. It is important to closely monitor patients receiving omalizumab for the development of side effects or worsening of their underlying disease conditions.
Author Block: L. Farhat1, D. Rastogi1, L. Bernstein2, A. Bidiwala1; 1Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States, 2Allergy and Immunology, The Children's Hospital at Montefiore, Bronx, NY, United States.
Introduction: The allergic triad of asthma, allergic rhinitis, and atopic dermatitis is commonly seen in both children and adults. Many of these patients have concurrent elevated levels of IgE. Anti-IgE [omalizumab] has been used with success for the treatment of severe asthma and allergic rhinitis, however with variable success when used for atopic dermatitis. We report an unusual case of a young man whose treatment with omalizumab severely exacerbated his atopic dermatitis.
Case description: 15 year old male with history of atopic dermatitis, moderate to severe persistent asthma, and allergic rhinoconjunctivitis presented at our pulmonology clinic. He had a history of significant sensitization to multiple aeroallergens as well as very elevated IgE levels. Despite being on maximal pharmacotherapy, he continued to have allergic rhinoconjunctivitis and asthma symptoms. The decision was then made to start him on omalizumab. A significant improvement was noted in his allergic rhinoconjunctivitis and asthma symptoms several weeks after initiating therapy. However, his eczema became severe despite an unchanged external environment. It was also noted that his eczema began worsening specifically in the evening after receiving omalizumab injections during the day. Omalizumab dosing was then spaced to every 4 weeks to minimize these exacerbations. Between doses his eczema would improve, only to flare again after receiving omalizumab. Considerable relief of symptoms was achieved after the patient was evaluated by dermatology and started pre-treatment with topical medications on scheduled omalizumab injection days.
Discussion: To our knowledge, severe exacerbation of atopic dermatitis has not been reported previously as a side effect of omalizumab therapy. The most common reported adverse effects are injection site reactions. More rarely, anaphylaxis has been reported to occur beyond one year after initiation of therapy. It is important to closely monitor patients receiving omalizumab for the development of side effects or worsening of their underlying disease conditions.
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