title: Omalizumab therapy in a 13-year-old boy with severe persistent asthma and concomitant eosinophilic esophagitis.
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) has been defined as "asthma of the esophagus" for the large number of similarities between the two diseases. Omalizumab is an anti-Immunoglobulin E (IgE) antibody currently approved only in allergic IgE-mediated severe persistent uncontrolled asthma and in chronic spontaneous urticaria unresponsive to antihistamines, but it has been tried in other diseases, too.
  
  
  METHODS
  We present herein the case of a 13-year-old boy, affected from preschool age by severe chronic allergic asthma poorly controlled despite a generous long-term therapy, and, since he was 8 years old, by eosinophilic esophagitis, responsive to courses of strict elimination diet and semi-elemental diet, even if very burdensome for his quality of life. At the age of 11.5 years, for inadequate asthma control, he started to receive therapy with omalizumab. After the first month and for the entire duration (18 months) of omalizumab treatment, asthma was well controlled, long-term conventional therapy was gradually withdrawn and lung- function improved. Concerning EoE, after an initial clinical but not histological remission during the first few months of treatment with omalizumab, the patient experienced an exacerbation of gastrointestinal symptoms. Therefore, he started treatment with topical steroids which was effective to improve gastrointestinal symptoms. However, EoE is still steroid-dependent. Currently, he continues both treatments: omalizumab for asthma and topical steroid for EoE.
  
  
  CONCLUSIONS
  This case report confirms that omalizumab is an effective treatment in patients with severe persistent, uncontrolled asthma. On the other hand, in our patient it did not produce persistent improvement neither on symptoms nor on biopsy findings of EoE. The outcome of this case might indicate different pathogenic mechanism(s) of the two diseases.
authors.affiliation: Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Arasi
authors.affiliation: Department of Pediatrics- Gastroenterology Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Department of Pediatrics- Gastroenterology Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magazzù
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ieni
authors.affiliation: Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crisafulli
authors.affiliation: Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Caminiti
authors.affiliation: Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Chiera
authors.affiliation: Department of Dermatology, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Vaccaro
authors.affiliation: Department of Pediatrics, II University of Naples, via De Crecchio 4, 80138, Naples, Italy.
authors.forename: Michele Miraglia
authors.initials: MM
authors.lastname: Del Giudice
authors.affiliation: Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, 98124, Messina, Italy. giovanni.pajno@unime.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Pajno
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D000069444:Omalizumab / Q000627:therapeutic use*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012882:Skin Tests
chemical_list: D018927:Anti-Asthmatic Agents; D000069444:Omalizumab
keywords: Eosinophilic esophagitis; Omalizumab; Severe persistent asthma; Topical steroids