1073 Role of Omalizumab in the Setting of Recalcitrate Dermatitis with Extremely Elevated IgE Levels

Wednesday, 14 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Muhammad Imran, MD , Allergy & Clinical Immunology, Kansas University Medical Center, Kansas City, KS

John Martinez, MD , Allergy & Clinical Immunology, Kansas University Medical Center, Kansas City, KS

Selina Gierer, DO , Allergy & Clincal Immunology, Kansas University Medical Center, Kansas city, KS


Omalizumab, the humanized recombinant monoclonal antibody against IgE, reduces serum free IgE and down-regulaties IgE receptors on mast cells and basophils. It is approved for the treatment of moderate to severe persistent asthma and chronic idiopathic urticarial. Bard et al. reported successful treatment of severe recalcitrant eczematous dermatitis in the setting of HIES with omalizumab. Due to high serum IgE level, recalcitrant dermatitis and prolonged usage of systemic corticosteroids, omalizumab was initiated in our patient with a favorable outcome.


A 54 year old man presented with a diffuse pruritic rash for 2 years. Physical examination revealed multiple discrete and confluent erythematous macules and plaques on the trunk, back, and all extremities. Laboratory findings showed extremely elevated IgE levels, 64285 IU/ML, absolute eosinophils 5,400 cells/μl, and a normal tryptase. Multiple skin biopsies showed non-specific dermatitis. Bone marrow biopsy, cytogenetics and imaging studies were unremarkable. The patient was evaluated by Dermatology and Hematology/Oncology, but no specific diagnosis was given. The patient denied a history of recurrent infections, skin abscesses, hyperextensible joints, bone fracture, or scoliosis. The patient had failed multiple systemic and topical medications, but improved with prednisone.


The patient was treated empirically with omalizumab 300 mg every 28 days.  One month after initiating omalizumab treatment, his dermatitis and eosinophilia markedly improved.


Although omalizumab was effective for our patient’s chronic dermatitis in the setting of severely elevated IgE, prospective studies and long term follow-up are required to confirm the efficacy of omalizumab in recalcitrate dermatitis and elevated IgE.