Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab.
Immunotherapy is an established mode of treatment for Hymenoptera venom anaphylaxis, although adverse reactions may occur. We report the case of a 33-year-old woman, the wife of a beekeeper, who experienced a systemic allergic reaction following a bee sting. Initial specific immunotherapy had to be stopped due to anaphylaxis (multiple immediate cardiovascular reactions). We looked for an alternative treatment option, and repeated immunotherapy accompanied by the anti-immunoglobulin (Ig) E monoclonal antibody omalizumab. Our new protocol was well tolerated. After 1 year of therapy, the patient was stung by a bee and developed only a slight local reaction, which resolved spontaneously. This result confirmed the success of our specific immunotherapy. We compared our results with those of 6 similar cases in the literature. AntiIgE has provided a treatment option for patients with severe IgE-mediated allergic disease that is difficult to treat. This case suggests that omalizumab may be able to prevent anaphylaxis during immunotherapy.
Galera
C
C
Allergy and Respiratory Diseases Unit, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France. celinegalera@yahoo.fr
Soohun
N
N
Zankar
N
N
Caimmi
S
S
Gallen
C
C
Demoly
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000276:immunology / Q000628:therapy*; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001514:Bee Venoms / Q000009:adverse effects* / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000069444:Omalizumab; D055815:Young Adult
D018926:Anti-Allergic Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001514:Bee Venoms; D000069444:Omalizumab; D007073:Immunoglobulin E