Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2008:74:2;157-158
doi: 10.4103/0378-6323.39708
PMID: 18388382

Omalizumab in severe chronic urticaria

KV Godse
 Consultant Dermatologist, Mumbai, India

Correspondence Address:
K V Godse
Shree Skin Centre, 22, L market, Sector 8, Nerul, Navi Mumbai - 400 706
India
How to cite this article:
Godse K V. Omalizumab in severe chronic urticaria. Indian J Dermatol Venereol Leprol 2008;74:157-158
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Urticaria patients are usually treated with oral antihistamines and 50% of them respond well to this treatment. However, the other 50% do not respond to antihistamines and need a more aggressive approach. Approximately 40-50% of patients with no apparent cause for their urticaria are believed to have an associated autoimmune profile that may play a pathogenetic role. We describe here a patient who responded to omalizumab after failure to respond to cyclosporine.

A forty-five-year old female presented with severe chronic urticaria prevalent for the last ten years and which did not respond to antihistamines and steroids. About five years ago, the patient was diagnosed to have sarcoidosis and was treated with oral steroids. She had developed osteoporosis due to repeated courses of oral steroids in the past. She also had a history of bronchial asthma, which was controlled with a bronchodilator. She was started on cyclosporine at a dose of 3 mg/kg in December 2006. Her urticaria was well controlled with cyclosporine until June 2007. Later, her urticaria worsened in spite of regular doses of cyclosporine and antihistamines in combination (hydroxyzine 25 mg three times a day and fexofenadine 180 mg daily). Hence, the dose of cyclosporine was doubled to 6 mg/Kg per day (300 mg) but her urticaria was not controlled. The addition of montelukast also did not help.

Her blood investigations including complete blood counts, biochemistry and thyroid stimulating hormone (TSH) were within normal limits. Serum protein electrophoresis was normal. Autologous serum skin test could not be performed as antihistamines could be not stopped even for a single day. Serum immunoglobulin E (IgE) was 778 as against the normal level of 100. At this stage, she was started on omalizumab 300 mg every four weeks in consultation with a chest physician in addition to cyclosporine, antihistamines and montelukast. After the first injection, she showed more than 90% control of her urticaria, while after the second injection, she had total relief from her symptoms, which lasted for four weeks.

Omalizumab, a recombinant, humanized, monoclonal antibody against immunoglobulin IgE, represents a unique therapeutic approach for the treatment of allergic diseases. This agent acts as a neutralizing antibody by binding IgE at the same site on IgE as its high-affinity receptor, F cεR I . Subsequently, IgE is prevented from sensitizing cells bearing high-affinity F cεR I receptors. Inhibition of the biological effects of IgE targets an early phase of the allergic cascade before the generation of allergic symptoms. [1] Omalizumab reduces serum levels of IgE and blocks the attachment of IgE to mast cells and other immune cells, thereby preventing IgE-mediated inflammatory changes. Omalizumab is approved for the treatment of moderate-to-severe persistent asthma in adults and adolescents older than 12 years of age who have a positive skin test to a perennial allergen. [2] Dosing is based on weight and pretreatment serum IgE levels and is administered via subcutaneous injection every 2-4 weeks. The safety profile of omalizumab is favorable with injection site reaction being the most commonly reported adverse event.

There are reports of the efficacy of omalizumab in chronic urticaria [3] and atopic dermatitis. [4] The incidence of anaphylaxis in clinical trials for omalizumab was 0.1%. [5] Boyce describes a successful treatment of cold urticaria with omalizumab. [6] Anti-IgE treatment induces the depletion of free IgE from the serum and tissue, leading ultimately to reduced binding of IgE to its high-affinity surface receptor, F cεR I . As occupancy of F cεR I by IgE determines the levels of surface F cεR I expression, this leads to a rapid depletion of both cell-bound IgE and surface F cεR I expression on blood basophils.

Omalizumab may have a beneficial effect in the treatment of chronic urticaria. Further studies are needed to confirm this effect and better elucidate the mechanism for the observed improvement.

References
1.
Mankad VS. Omalizumab: Other indications and unanswered questions. Clin Rev Allergy Immunol 2005;29:17-30.
[Google Scholar]
2.
Graves JE, Nunley K, Heffernan MP. Off-label uses of biologics in dermatology: Rituximab, omalizumab, infliximab, etanercept, adalimumab, efalizumab and alefacept. J Am Acad Dermatol 2007;56:e55-79.
[Google Scholar]
3.
Spector SL, Tan RA. Effect of omalizumab on patients with chronic urticaria. Ann Allergy Asthma Immunol 2007;99:190-3.
[Google Scholar]
4.
Forman SB, Garrett AB. Success of omalizumab as monotherapy in adult atopic dermatitis: Case report and discussion of the high-affinity immunoglobulin E receptor, Fcepsilon RI. Cutis. 2007;80:38-40.
[Google Scholar]
5.
Scheinfeld N. Omalizumab: A recombinant humanized monoclonal IgE-blocking antibody. Dermatol Online J 2005;11:2.
[Google Scholar]
6.
Boyce JA. Successful treatment of cold-induced urticaria/anaphylaxis with anti-IgE J Allergy Clin Immunol 2006;117: 1415-8.
[Google Scholar]

Fulltext Views
381

PDF downloads
131
Show Sections