Omalizumab
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Drug hypersensitivity: 3 case reports Three patients developed drug hypersensitivity while receiving omalizumab for asthma [route not stated]; they were successfully treated with a desensitisation regimen, and then continued to receive omalizumab at half the previous dose administered at twice the frequency. A 32-year-old woman started receiving omalizumab at a dose of 225mg every 2 weeks. One and a half years later, 3 hours after injection of omalizumab, she developed dyspnoea, cough and tachycardia. Her FEV1 decreased from 89% to 78%. She received methylprednisolone, salbutamol [albuterol] and diphenhydramine, and improved. After several days, her asthma exacerbation resolved. Three months later, skin prick testing with omalizumab was negative. She received omalizumab 75mg and tolerated it well. The next day she received 150mg and within minutes developed dyspnoea, itchy eyes and decreased FEV1 (58%). She received epinephrine [adrenaline], diphenhydramine and methylprednisolone, and improved. The next day, she developed urticaria. Over 1 week, her symptoms resolved and FEV1 improved to 93%. Omalizumab was stopped for 1 year. Desensitisation was then conducted; halfway through, she developed dyspnoea, coughing and nausea, but the symptoms resolved. She continued to receive omalizumab weekly without further hypersensitivity. A 21-year-old woman started receiving omalizumab 375mg every 2 weeks. Three months later, 20 minutes after her omalizumab injection, she developed eye swelling and nasal congestion. She received diphenhydramine, but her symptoms worsened and she went to an emergency department with throat tightness, facial and tongue swelling and wheezing. She received epinephrine and methylprednisolone and was discharged. During omalizumab desensitisation, she developed pruritus and wheezing and required diphenhydramine. Two weeks later, she received the target dose of omalizumab 187.5mg. One hour later, she had chest, throat and ocular pruritus and nasal discharge, with chest erythema. Her symptoms resolved spontaneously and she continued to receive weekly omalizumab without further hypersensitivity. A 41-year-old woman started receiving omalizumab 300mg monthly. After 3 months, she developed urticaria immediately after the injection, which lasted for 2–3 days. The reaction persisted for several injections. Omalizumab was discontinued. During desensitisation, she developed mild chest tightness, which resolved with salbutamol. After desensitisation, she had mild dyspnoea after her second injection of omalizumab, which lasted for 2 days and was treated with salbutamol. She continued to receive omalizumab biweekly without further hypersensitivity. Owens G, et al. Successful desensitization of three patients with hypersensitivity reactions to omalizumab. Current Drug Safety 6: 339-342, No. 5, Nov 2011. Available from: URL: http://dx.doi.org/10.2174/157488611798918692 803068429 USA
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Reactions 24 Mar 2012 No. 1394
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