Imported fire ant rush desensitization using omalizumab and a premedication regimen

Abstract

Imported fire ant (IFA) whole-body extract (WBE) rush immunotherapy (RIT) is a safe and effective means to reach the recommended maintenance dose of 0.5 mL (1:100 wt/vol). 1 Tankersley M.S. Walker R.L. Butler W.K. Hagan L.L. Napoli D.C. Freeman T.M. Safety and efficacy of an imported fire ant rush immunotherapy protocol with and without prophylactic treatment. J Allergy Clin Immunol. 2002; 109: 556-562 Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar , 2 Golden D.B. Moffitt J. Nicklas R.A. et al. Sting insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol. 2011; 127: 852-854.e23 Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar Omalizumab, an anti-IgE monoclonal antibody, has been reported as a useful adjunct to venom immunotherapy (IT) protocols. 3 da Silva E.N. Randall K.L. Omalizumab mitigates anaphylaxis during ultrarush honey bee venom immunotherapy in monoclonal mast cell activation syndrome. J Allergy Clin Immunol Pract. 2013; 1: 687-688 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 4 Galera C. Soohun N. Zankar N. Caimmi S. Gallen C. Demoly P. Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol. 2009; 19: 225-229 PubMed Google Scholar , 5 Palgan K. Bartuzi Z. Gotz-Zbikowska M. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting. Int J Immunopathol Pharmacol. 2014; 1: 109-112 Google Scholar We report the case of a patient who was unable to reach the recommended maintenance dose on a conventional IFA WBE IT buildup schedule because of repeated systemic reactions. After omalizumab therapy was initiated, IFA WBE RIT with antihistamine and corticosteroid premedication was successfully completed.