OMALIZUMAB FOR SKEETER SYNDROME: THREE SUCCESSFULLY TREATED PATIENTS

Abstract

<h3>Introduction</h3> Skeeter syndrome is a rare disease associated with an overwhelming immunologic response to proteins in mosquito saliva. Typical symptoms include large local reactions, hives, swelling, blisters, fever, malaise and rarely anaphylaxis. Prevention measures include mosquito avoidance, use of insect repellants and prophylaxis with oral nonsedating H1 antihistamines. Systemic steroids are often required for severe cases. To date there is no FDA-approved treatment for Skeeter syndrome. Thousands of patients in Skeeter syndrome support groups express dissatisfaction with the lack of treatment options. Allergists have similarly been frustrated by the lack of options available for their Skeeter syndrome patients. Case reports have demonstrated the efficacy of omalizumab in treating other blistering disorders such as bullous pemphigoid. I hypothesized that omalizumab would be effective for reducing the severity of these reactions in patients who continue to suffer despite avoidance measures and standard of care. <h3>Case Description</h3> I treated three adult patients with Skeeter syndrome with 300 mg of omalizumab every four weeks initiated one month prior to the onset of summer. Treatment was continued throughout the duration of summer months when mosquito exposure remained highest. Among the three patients treated with omalizumab, over 100 bites were sustained during therapy. All three patients demonstrated a rapid improvement in the size of their local reactions with no further development of bullae after the first dose of omalizumab. <h3>Discussion</h3> This report highlights a potential therapeutic option for a rare disease and calls for further studies to demonstrate the efficacy of omalizumab for Skeeter syndrome.