Open AccessOmalizumab ensures compatibility to bee venom immunotherapy (VIT) after VIT-induced anaphylaxis in a patient with systemic mastocytosis
Author(s) -
Aşkın Gülşen,
Franziska Ruëff,
Uta Jappe
Publication year - 2021
Publication title -
allergologie select
Language(s) - English
Resource type - Journals
ISSN - 2512-8957
DOI - 10.5414/alx02196e
Subject(s) - anaphylaxis , systemic mastocytosis , omalizumab , medicine , sting , bee venom , venom , immunology , dermatology , allergy , mast cell , immunoglobulin e , biology , antibody , engineering , aerospace engineering , zoology , ecology
Systemic reactions and anaphylaxis due to Hymenoptera venoms occur in up to 7.5% of the European population. Fatal sting reactions are very rare. Serum tryptase levels should be measured in all patients with a history of severe reactions in order to detect mastocytosis and to determine the risk of severe reactions to venom immunotherapy (VIT). The risk to experience severe or even fatal anaphylaxis due to insect stings is quite high in patients with mastocytosis. Therefore, lifelong VIT is recommended in these highly threatened patients. Multicenter studies involving a large population report that up to 20% of patients undergoing VIT have intolerance and systemic reactions to immunotherapy. Some of these side effects occur repeatedly and cannot be managed by standard treatment. A pre-treatment with the anti-IgE antibody omalizumab was useful in many cases. However, omalizumab is not approved for the indication anaphylaxis. Therefore, there is still no defined protocol for omalizumab pre-treatment, and the optimal duration, dosage as well as long-time benefits are still unclear.