Granulomatous foreign-body reaction with facial dermal fillers after omalizumab treatment for severe persistent allergic asthma: a case report

Abstract

Madam, During the past few decades, an increasing number of soft‐tissue filler substances have been introduced to the beauty market worldwide for treating age wrinkles, correcting atrophic scars or small cutaneous defects, and cosmetically augmenting soft tissue of different parts of the body.1 Although these injectable fillers are considered safe, significant adverse reactions may occur.2 As was reported with interferon alfa, new immunomodulatory therapies used for inflammatory and allergic disease may produce a foreign‐body granulomatous reaction in patients injected with dermal fillers.3 We report on a case of a patient who had received hyaluronic acid (HA) and calcium hydroxylapatite injections and showed foreign‐body granulomatous reaction after omalizumab administration for severe persistent allergic asthma. A 50‐year‐old white woman with facial erythematous nodules was referred to our clinic. She had received treatment for adult‐onset severe allergic asthma with maximal inhaled corticosteroids and montelukast, but the asthma remained poorly controlled, with frequent exacerbations requiring monthly courses of oral steroids. A 16‐week trial treatment with omalizumab (300 mg subcutaneously per month) was started. The last short course of oral steroids for an exacerbation was stopped 10 days before the first administration of omalizumab.