Dose-dependence of protection from systemic reactions to venom immunotherapy by omalizumab.

Elisa Boni,Cristoforo Incorvaia,Marina Mauro

doi:10.1186/s12948-016-0051-2

Abstract

BackgroundSystemic reactions (SR) to venom immunotherapy (VIT) are rare but may occur, with a rate significantly higher for honeybee than for vespid VIT. In patients with repeated SRs to VIT it is difficult to reach the maintenance dose of venom and pre-treatment with omalizumab is indicated, as shown by some studies reporting its preventative capacity, when antihistamines and corticosteroids are ineffective.Case presentationWe present the case of a 47 years old woman allergic to bee venom who experienced two severe SRs after bee stings and several SRs to VIT with bee venom. Pre-treatment with antihistamines and corticosteroids as well as omalizumab at doses up to 300 mg was unsuccessful, while an omalizumab dose of 450 mg finally achieved in our patient the protection from SRs to VIT with 200 mcg of bee venom.ConclusionsThe search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions.

Highlights

Systemic reactions (SR) to venom immunotherapy (VIT) are rare but may occur, with a rate significantly higher for honeybee than for vespid VIT
The search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions
VIT is a highly effective treatment but not all patients are protected from SRs by the usual maintenance dose of 100 mcg

Summary

Conclusions

VIT is a highly effective treatment but not all patients are protected from SRs by the usual maintenance dose of 100 mcg. Rueff et al demonstrated that in all patients not completely protected from stings a protective dose may be individuated, that in rare cases may be as high as 400 mcg [9]. The case we report shows that the search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this pursuit is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions. Author details 1 Allergy Unit, Sant’Anna Hospital, ASST Lariana, Via Napoleona 60, 22100 Como, Italy.

Background