Abstract
BackgroundOmalizumab is a human IgG1 antibody against IgE used as a therapy for sever asthmatic patients with asthma. According to the guidelines of the Global Initiative for Asthma, omalizumab is an add-on drug at treatment step 5 that is used for severe asthma patients who are allergic to perennial allergens. The effects of omalizumab for severe asthma therapy have been validated in multiple clinical studies. However, the long-term effects of omalizumab on IgE production and possibility of resetting of administration dose of omalizumab remain unknown.Case PresentationThe serum total and free IgE levels were measured over time in a 63-year-old female patient with allergic asthma who was administered 375 mg omalizumab biweekly for 36 months. Her symptoms did not worsen and clinical course remained favorable after reducing the dose to 375 mg per month. The serum free IgE levels temporarily increased following a dose reduction of omalizumab. The serum free IgE trough level temporarily increased at 4 weeks after capable to reduce the dosage; however, thereafter, the serum free IgE level decreased to desired levels (below 30 ng/mL).ConclusionsThe present case shows the possibility of reducing the dose following the long-term use of omalizumab. Considering the high medical cost of omalizumab, the dose reduction may be a viable option. It may be useful to measure the serum free IgE level to appropriately identify patients in whom the dose can be reduced, and to carefully monitor the clinical course.
Highlights
Omalizumab is a human IgG1 antibody against IgE used as a therapy for sever asthmatic patients with asthma
To the editor Omalizumab is a human IgG1 antibody against IgE used to treat patients with severe allergic asthma with symptoms that are poorly controlled with high doses of inhaled steroids
The goal of omalizumab therapy is to achieve free IgE of ≤25 ng/mL [1]; it is impossible to distinguish between free IgE and IgE-omalizumab complexes using conventional measurements of serum total IgE
Summary
The present case shows the possibility of reducing the dose of omalizumab following its. Considering the high medical cost of omalizumab, reduction of the dose may be a viable option. In such a case, it is useful to measure the serum free IgE level to appropriately identify patients in whom the dose can be reduced. Because there are patients similar to the present study in whom serum free IgE levels temporarily increase following a dose reduction of omalizumab, it is recommended that their clinical courses be carefully monitored by observing their serum free IgE levels. SS, KM, IY, and SH revised the manuscript. All authors approved the final manuscript for publication. All authors read and approved the final manuscript
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