Role of Omalizumab in Rush Cow's Milk Desensitization in the Outpatients Office

Abstract

Milk desensitization protocols are widely extended at inpatients Allergy clinics. The main objetive was to complete a cow′s milk (CM)desensitization rush protocol with the adyuvant use of omalizumab under outpatients setting. We present a 7 year-old girl with a confirmed diagnosis of severe persistent anaphylaxis to CM. No other atopic conditions were present. No controlled challenges were performed as minimal unwanted contacts with dairy products (even traces) were able to elicit immediate systemic symptoms. Diagnostic work-up showed a total IgE of 614 UI/L with specific IgE (kU/l) to casein: 20.0; alfa-lactoalbumin: 16.7 and beta-lactoglobulin: 18.4. A total cummulative dose of Omalizumab 600 mg (300 mg every two-weeks) was only administered four weeks prior to desensitization. Clinical follow-up was strictly observed during the whole protocol. On the first day, the proposed rush schedule included dosing up (every 30 minutes) with both diluted (1/10) and undiluted CM up to a maximal dose of 4 ml.This daily manteinance dose (4 ml) was also weekly –doubled to a maximal dose of 250 ml. in seven weeks. A final dose of 250 ml were reached in seven weeks. No adverse reactions were observed and no medication was needed either. No late-phase adverse events reactions were present. The inclusion of Omalizumab in the food desensitization protocols could play a role as a usefull adyuvant tool specially in those patients with a high sensitization who require to be managed in the outpatient office. Further studies are needed to evaluate the optimal duration of Omalizumab in long-term food desensitization