Background

Patients with idiopathic anaphylaxis (IA) may fail to respond to a combination of high-dose H₁ and H₂ antihistamines and mast cell stabilizers. Treatment options for these patients are currently limited.

Objective

To describe the clinical experience of omalizumab use for the treatment of patients with IA with no evidence of underlying clonal mast cell disorders.

Methods

We performed a retrospective review at 2 separate institutions of medical records of patients with a diagnosis of IA without evidence of mast cell clonality who had received treatment with omalizumab. We searched PubMed for studies describing omalizumab use in similar patients. Information on symptoms and omalizumab therapy was compiled, and response pattern of anaphylaxis was determined.

Results

A total of 35 patients with IA and no evidence of mast cell clonality who received omalizumab were identified. The median age was 36 years at the start of omalizumab (range, 11-54 years; n = 29). The frequency of anaphylaxis episodes before omalizumab treatment varied from 2 total episodes to several episodes per month. The most often used initial omalizumab dose was 300 mg every 4 weeks (n = 16). Most patients ultimately achieved clinical response after starting omalizumab: complete response (63%, n = 22), partial response (28.5%, n = 10), with 3 nonresponders.

Conclusion

Omalizumab may be an effective treatment option for patients with IA who do not have evidence of mast cell clonality and fail to respond to antihistamines and mast cell stabilizers.

中文翻译：

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使用奥马珠单抗治疗特发性过敏反应

背景

特发性过敏反应 (IA) 患者可能对高剂量 H ₁和 H ₂抗组胺药和肥大细胞稳定剂的组合没有反应。这些患者的治疗选择目前有限。

客观的

描述使用奥马珠单抗治疗无潜在克隆性肥大细胞疾病证据的 IA 患者的临床经验。

方法

我们在 2 个独立机构对接受奥马珠单抗治疗的无肥大细胞克隆证据的 IA 诊断患者的医疗记录进行了回顾性审查。我们在 PubMed 中搜索了描述在类似患者中使用奥马珠单抗的研究。汇总了有关症状和奥马珠单抗治疗的信息，并确定了过敏反应的反应模式。

结果

共有 35 名接受奥马珠单抗治疗的 IA 患者没有肥大细胞克隆性证据。奥马珠单抗开始时的中位年龄为 36 岁（范围，11-54 岁；n = 29）。奥马珠单抗治疗前过敏反应发作的频率从总共 2 次发作到每月几次发作不等。最常用的奥马珠单抗初始剂量为每 4 周 300 毫克（n = 16）。大多数患者在开始使用奥马珠单抗后最终达到临床反应：完全反应（63%，n = 22），部分反应（28.5%，n = 10），3 名无反应者。

结论

对于没有肥大细胞克隆性证据且对抗组胺药和肥大细胞稳定剂无反应的 IA 患者，奥马珠单抗可能是一种有效的治疗选择。