Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

Abstract

Childhood urticaria is not rare, although its persistence is less frequent. In children, chronic spontaneous urticaria (CSU) is associated with comorbidities, including asthma, allergic rhinitis, or atopic dermatitis, and many children with CSU have a family history of atopy. The therapeutic approach to CSU in children is the same one recommended by international guidelines for treatment of chronic urticaria in adults. In the European Union, according to the European Medicine Agency, omalizumab is the add-on drug of choice for the management of CSU in adult and adolescent patients (from 12 years of age) with inadequate response to H1 antihistamine therapy. In addition, in children (6 to <12 years of age), it is the add-on therapy of choice to improve asthma control. The management of children with urticaria under 12 is a therapeutic area with few certainties, where omalizumab can be administered only “off-label.”

New Perspectives in Food Allergy

“…Almost half of patients with IgE-dependent FA have experienced at least one serious anaphylactic reaction, especially in childhood and adolescence [11,19]. The variability of clinical expressions and the complexity of the underlying immunological mechanisms contribute to making diagnosis often difficult and complicate the studies on the epidemiology of FA [20][21][22][23][24][25][26][27][28][29][30].…”

“…Omalizumab, by linking the Fc region of IgE antibodies and blocking the binding of IgE to FcεRI on mastcells and basophils, prevents the degranulation of these cells and the consequent clinical manifestations triggered by the released mediators [29,30,162]. Omalizumab, already successfully tested in various IgE-mediated pathologies [28], is also usefully associated with the OIT to treat FA. Before starting OIT, to obtain a reduction of the levels of free IgE and to induce a downregulation of the FcεRI expression on the surface of mastcells and basophils, patients are treated with biweekly or monthly omalizumab injections for 8 weeks [163].…”

Omalizumab in children and adolescents with chronic spontaneous urticaria: Case series and review of the literature

“…[8][9][10][11][12][13] Real-life experience information on the use of omalizumab among children and adolescents is based primarily on a few of clinical cases described in the literature (Table 3). [14][15][16][17][18][19][20][21][22] Authors have raised concerns about the standard dosage of 300 mg every 4 weeks. Sirufo et al described the case of an 8year-old boy with CSU and allergic asthma: this patient was treated with omalizumab at the recommended dosage for asthma in children (75 mg monthly for 6 months), resulting in remission of urticaria over 1 year after the discontinuation.…”

“…Sirufo et al described the case of an 8year-old boy with CSU and allergic asthma: this patient was treated with omalizumab at the recommended dosage for asthma in children (75 mg monthly for 6 months), resulting in remission of urticaria over 1 year after the discontinuation. 14 course nor the follow-up after discontinuation of treatment were reported. 19 Finally, Olszowiec-Chlebna et al reported the first successful case of using omalizumab as a preventive therapy for idiopathic anaphylaxis concomitantly with CSU in a teenager.…”

Does Allergy Break Bones? Osteoporosis and Its Connection to Allergy

“…Epidemiological evidence is reported on the association between chronic urticaria (CU) and osteoporosis [76]. CU as a low grade inflammatory condition [77][78][79] is a potential risk factor for osteoporosis, to which the female predisposition and the exposure to systemic corticosteroids is added. We do not have physiopathological certainties on the high prevalence of osteoporosis in CU patients, but only speculations about the possible roles of chronic inflammation and mast cell abnormalities connecting these two pathologies.…”