title: Dose-dependence of protection from systemic reactions to venom immunotherapy by omalizumab.
abstract: BACKGROUND
  Systemic reactions (SR) to venom immunotherapy (VIT) are rare but may occur, with a rate significantly higher for honeybee than for vespid VIT. In patients with repeated SRs to VIT it is difficult to reach the maintenance dose of venom and pre-treatment with omalizumab is indicated, as shown by some studies reporting its preventative capacity, when antihistamines and corticosteroids are ineffective.
  
  
  METHODS
  We present the case of a 47 years old woman allergic to bee venom who experienced two severe SRs after bee stings and several SRs to VIT with bee venom. Pre-treatment with antihistamines and corticosteroids as well as omalizumab at doses up to 300 mg was unsuccessful, while an omalizumab dose of 450 mg finally achieved in our patient the protection from SRs to VIT with 200 mcg of bee venom.
  
  
  CONCLUSIONS
  The search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions.
authors: Allergy Unit, Sant'Anna Hospital, ASST Lariana, Via Napoleona 60, 22100 Como, Italy.
authors: Elisa
authors: 0000-0003-2644-1114
authors: E
authors: Boni
authors: Allergy/Cardiac and Pulmonary Rehabilitation ASST G. Pini/CTO, Via Bignami 1, 20126 Milan, Italy.
authors: Cristoforo
authors: C
authors: Incorvaia
authors: Allergy Unit, Sant'Anna Hospital, ASST Lariana, Via Napoleona 60, 22100 Como, Italy.
authors: Marina
authors: M
authors: Mauro
keywords: Honeybee; Omalizumab; Systemic reactions; Venom immunotherapy