Efficacy of long-term treatment with omalizumab in a food and inhalant allergy patient

Omalizumab, a recombinant humanized immunoglobulin G1 (IgG1) monoclonal antibody, binds C-e-3 region of free immunoglobulin E forming complexes that prevent the IgE interaction with their receptors [1]. Treatment with omalizumab produces a decrease in free immunoglobulin E (IgE) levels and consequently reduces the expression of the high affinity FceRI receptor on the surface of mast cells and basophils [2].
In clinical practice, omalizumab is approved for treatment of patients with moderate-severe persistent perennial asthma and, since 2014, for treatment of chronic spontaneous urticaria (CSU) which are uncontrolled by conventional anti-H1 treatment [3].
In the literature there is increasing evidence of a possible efficacy of an anti-IgE therapy also in other allergic diseases (allergic rhinitis, nasal polyps, food allergy, eosinophilic gastrointestinal, etc.) [4] and in immune-mediate disorders including hypocomplementemic urticarial vasculitis syndrome (HUVS) [5].
We describe the case of a 10-year-old child with atopic dermatitis, hen’s egg, cow’s milk and peanut hypersensitivity (asthma, urticaria), persistent rhinitis and asthma since a few months of age.
We performed a complete allergological testing including:
– skin prick tests (SPTs), performed with major food and inhalant allergens (Lofarma, Milan, Italy), and positive and negative controls (histamine 10 µg/ml and saline solution) according to the EAACI recommendations [6];
– assays of serum total IgE, specific IgE and IgG4 for major inhalant and food allergens performed by UniCAP System (Pharmacia, Uppsala, Sweden);
– Basophil Activation Test (BAT) for major food allergens.
This evaluation showed a sensitization to dermatophagoides spp., alternaria, yolk and egg white, milk, dried fruits and lipid transfer protein (LTP).
During the years the patient’s allergological evaluation was repeated to monitor his allergic conditions; moreover he continued to experience severe asthma exacerbations that were not controlled by symptomatic treatment and standard allergen-specific immunotherapy requiring recurrent high doses of oral corticosteroids. For these reasons, in 2014 the young patient started omalizumab treatment (300 mg monthly) according to guidelines [7].
The young patient immediately had a complete remission of his respiratory condition (allergic rhinitis and bronchial asthma); in fact, he obtained a good control of his bronchial asthma again...


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