Allergy Asthma Respir Dis.  2015 Sep;3(5):380-383. 10.4168/aard.2015.3.5.380.

Favorable outcome of omalizumab treatment in a patient with idiopathic anaphylaxis

• Ban GY
• Yang EM
• Kim JH
• Shin YS
• Ye YM
• Nahm DH
• Park HS

• KMID: 2218651
• DOI: http://doi.org/10.4168/aard.2015.3.5.380

Abstract

Anaphylaxis is a severe and life-threatening systemic reaction. Despite the extensive evaluation to determine the cause, 30%-60% of cases of anaphylaxis in adults remain idiopathic. Recently, omalizumab treatment has been postulated to treat refractory idiopathic anaphylaxis. We report a case of idiopathic anaphylaxis treated with omalizumab and investigated its pharmacological mechanism. A 66-year-old female presented to our clinic with recurrent anaphylaxis. She suffered from anaphylaxis 2-3 times a month for 6 months. She had past medical history of nonallergic bronchial asthma. History was carefully undertaken and anaphylaxis was not related to any specific foods, drugs, exercise, and insect bites. Serum specific IgE antibodies to common food allergens showed negative results. Oral provocation tests to food additives revealed to be negative. To screen systemic mastocytosis and mast cell activating syndrome, baseline tryptase level was checked, and it was within normal range. From comprehensive evaluation, she was diagnosed as having idiopathic anaphylaxis. She could not tolerate oral medications due to gastrointestinal discomfort, therefore, omalizumab treatment (150 mg, monthly) was started. After 6 months of treatment, anaphylaxis did not occur with complete remission status. To evaluate the pharmacological mechanism of omalizumab treatment, basophil histamine releasability test was performed. Histamine releasability induced by anti-IgE did not change after 6 months of treatment, while that induced by calcium inophore decreased. Omalizumab treatment can induce remission or favorable effects on idiopathic anaphylaxis, which may be derived from increased threshold of mast cell degranulation. Long-term studies in a larger cohort will be needed to confirm its efficacy.

Keyword

Anaphylaxis; Idiopathic; Omalizumab treatment

MeSH Terms

Adult
Aged
Allergens
Anaphylaxis*
Antibodies
Asthma
Basophils
Calcium
Cohort Studies
Female
Food Additives
Histamine
Humans
Immunoglobulin E
Insect Bites and Stings
Mast Cells
Mastocytosis, Systemic
Reference Values
Tryptases
Omalizumab
Allergens
Antibodies
Calcium
Food Additives
Histamine
Immunoglobulin E
Tryptases

Figure

• 

  Fig. 1 Basophil histamine releasability of 2 normal controls and the patient before and after anti-IgE treatment. *Indicates histamine decreased by 61.5%.

Reference

1. Wood RA, Camargo CA Jr, Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014; 133:461–467.

2. Ye YM, Kim MK, Kang HR, Kim TB, Sohn SW, Koh YI, et al. Predictors of the severity and serious outcomes of anaphylaxis in korean adults: a multicenter retrospective case study. Allergy Asthma Immunol Res. 2015; 7:22–29.

3. Greenberger PA. Idiopathic anaphylaxis. Immunol Allergy Clin North Am. 2007; 27:273–293, vii-viii.

4. Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010; 126:477–480.e1-42.

5. Jones JD, Marney SR Jr, Fahrenholz JM. Idiopathic anaphylaxis successfully treated with omalizumab. Ann Allergy Asthma Immunol. 2008; 101:550–551.

6. Demirturk M, Gelincik A, Colakoglu B, Dal M, Buyukozturk S. Promising option in the prevention of idiopathic anaphylaxis: omalizumab. J Dermatol. 2012; 39:552–554.

7. Warrier P, Casale TB. Omalizumab in idiopathic anaphylaxis. Ann Allergy Asthma Immunol. 2009; 102:257–258.

8. Kim S, Yoon SY, Park SY, Kwon HS, Cho YS, Moon HB, et al. A case of idiopathic anaphylaxis followed by acute liver injury. Allergy Asthma Immunol Res. 2013; 5:245–247.

9. Hur GY, Sheen SS, Kang YM, Koh DH, Park HJ, Ye YM, et al. Histamine release and inflammatory cell infiltration in airway Mucosa in methylene diphenyl diisocyanate (MDI)-induced occupational asthma. J Clin Immunol. 2008; 28:571–580.

10. Wong S, Yarnold PR, Yango C, Patterson R, Harris KE. Outcome of prophylactic therapy for idiopathic anaphylaxis. Ann Intern Med. 1991; 114:133–136.

11. Normansell R, Walker S, Milan SJ, Walters EH, Nair P. Omalizumab for asthma in adults and children. Cochrane Database Syst Rev. 2014; 1:CD003559.

12. Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013; 131:110–116.e1.

13. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69:868–887.

14. Chang TW, Shiung YY. Anti-IgE as a mast cell-stabilizing therapeutic agent. J Allergy Clin Immunol. 2006; 117:1203–1212.