Methods:
A 16-year-old patient of ours with an allergic rhinoconjunctivitis developed a similar situation. The patient's complaints began 4 years previously.
Results: The patient's skin prick test was +4 positive with mite, +4 positive with olive, and +4 positive with Parietaria judaica (Judas tree). Blood level of total IgE was 645 IU / L. We planned SIT with the beginning at doses (ST allergens APSI, 2 numbered bottle, 5 doses). SIT was stopped due to exacerbation of skin lesions resistant to antihistamines and topical steroids. Omalizumab treatment started at a dose 375 mg every 2 weeks. After 2 months of treatment, when the skin lesions had been brought under control, we started SIT treatment again and this time no recurrence of the lesion was observed. This patient had taken omalizumab and SIT combination therapy for 3 years. Omalizumab can possibly overcome these limitations by binding exclusively to circulating IgE molecules and reducing the levels of circulating IgE, regardless of allergen specificity, by binding to the constant region of circulating IgE molecules. This prevents free IgE from interacting with the high- and low-affinity IgE receptors (Fc"RI and Fc"RII) on mast cells, basophils, macrophages, dendritic cells, and B lymphocytes, and subsequently leads to a decrease in the release of the mediators of the IgE mediated allergic response (ie, cytokines, histamines, and leukotrienes).
Conclusions: Studies in patients with allergic rhinitis and asthma have shown that pre-treatment with omalizumab may be an effective option to safely reduce systemic anaphylactic reactions and achieve a higher dose of allergen immunotherapy.