Italian Journal of Prevention, Diagnostic and Therapeutic Medicine

Abstract

IntroductionOmalizumab is a monoclonal anti-IgEantibody,indicated as an add-on therapy in patients with severe uncontrolled asthma. Therapy is guided by a nomogram based on total IgE and patients’weights. AimAim of this case is to describe off-label treatment with omalizumab and demonstrate effectiveness of this treatment despite high total IgE. Case presentationWe present a case of a patient followed in our Paediatric Allergology Centre since 2012 for allergic severe persistent asthma, treated with maximal dosage of fluticasone, montelukast, continuous salmeterol and steroid cycles, without clinical and spirometric changes. Despite high total IgE of the patient and with his consent , we decided to initiate treatment with omalizumab (600 mg every 15 days) with progressive improvement of spirometry and negative bronchodilation tests. At the end of treatment, we noticed a sudden worsening of spirometry and a significant asthma exacerbation over period of 6 months of treatment with omalizumab. Based on these data, he has renewed omalizumab. ConclusionWe reported a case of an adolescent treated off-label with omalizumab. The case tests how patients with severe allergic asthma can benefit from therapy with omalizumab despite high totalIgE. Further studies will be necessary to evaluate the long-term beneficial effects of this therapeutic choice.