Title: Literature Review and Current Treatment Options for Cyclical Anaphylaxis
Authors: Burke A, Kiers D, Lee JK.
Background: Cyclical anaphylaxis is a rare reaction occurring in the luteal phase of menstruation. Presentation may include dyspnea, respiratory distress, cutaneous and gastrointestinal symptoms. Previous successful treatment options of this condition have been limited to medical or surgical ovulatory suppression. At present, the use of IgE-inhibition with the drug omalizumab has shown success in multiple individuals, making it the favorable treatment over oophorectomy for women looking to conceive. We report the first successful case series of four patients treated with omalizumab for cyclical anaphylaxis.
Methods: A literature review was conducted of published data pertaining to cyclical anaphylaxis in the luteal phase of menstruation. This information was summarized and the four patients from our center were included in this summary.
Results: Omalizumab has resulted in symptom resolution or significant reduction in symptoms in all four patients. There is no consistent literature definition of cyclical anaphylaxis and the nomenclature of similar and/or overlapping conditions makes any uniform treatment decisions challenging to make consensus recommendations for. For cyclical urticaria and anaphylaxis, omalizumab and represents a safer and preferable treatment option for this rare condition(s).
Conclusion: Through evaluating data regarding the use of omalizumab it can be noted that this is the preferred treatment of cyclical anaphylaxis for women who would like to maintain the option of conception later in life. Continued research is necessary in order to fully understand the generalizability and reliability of study data to the population. We also propose a more systematic classification of this and related conditions to better direct future research.