Experience of long-term use of anti-IgE therapy in a patient with chronic spontaneous urticarial
https://doi.org/10.21518/2079-701X-2022-16-6-176-180
Abstract
Chronic spontaneous urticaria is an urgent health problem. Recurrent urticarial rashes, angioedema and severe itching reduce the quality of life of patients. The ineffectiveness of standard therapy requires the search for new modern methods of treating this disease. Taking into account the current data on the pathogenesis, the third line of therapy for chronic spontaneous urticaria is the addition of anti-IgE therapy (omalizumab) to antihistamines of the 2nd generation. The presented clinical case is devoted to the experience of long-term use of omalizumab in a patient with chronic spontaneous urticaria. Having a disease duration of about a year, the patient was thoroughly examined, all concomitant diseases were identified and compensated, parasitic invasion was treated, but this did not lead to a regression of symptoms. Antihistamines of the 2nd generation in standard and increased doses (up to 4 times) did not control the disease, systemic glucocorticosteroids stopped the symptoms for a short time, and therefore, in the future, the patient began to use them independently and uncontrollably. Almost daily use of corticosteroids for 6 months caused the development of complications in the form of weight gain and Cushing’s syndrome. Omalizumab completely stopped all the symptoms during the first day, no side effects were detected. The clinical effect lasted from 3 to 4 weeks. Thus, omalizumab therapy allowed the patient to almost completely get rid of the symptoms of CSC, which significantly improved the quality of life and made it possible to cancel systemic glucocorticosteroids. The peculiarity of the presented case is the duration of the use of omalizumab (more than 2 years) with the inability to cancel due to the return of urticarial rashes and itching.
About the Authors
E. A. Sobko
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Krasnoyarsk Clinical Regional Hospital
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course, 1, Partizan Zeleznyak St., Krasnoyarsk, 660022;
Head of Allergology Department, 3a, Partizan Zeleznyak St., Krasnoyarsk, 660022
I. V. Demko
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Krasnoyarsk Clinical Regional Hospital
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Head of Department of Hospital Therapy and Immunology with Postgraduate Education Course, 1, Partizan Zeleznyak St., Krasnoyarsk, 660022;
Head of Pulmonary Allergology Сenter, 3a, Partizan Zeleznyak St., Krasnoyarsk, 660022
N. A. Shestakova
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Krasnoyarsk Clinical Regional Hospital
Russian Federation
Russian Federation
Cand. Sci. (Med.), Assistant, Associate Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course, 1, Partizan Zeleznyak St., Krasnoyarsk, 660022;
Allergologist-Immunologist, Allergology Department, 3a, Partizan Zeleznyak St., Krasnoyarsk, 660022
A. Yu. Kraposhina
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Krasnoyarsk Clinical Regional Hospital
Russian Federation
Russian Federation
Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course, Professor, 1, Partizan Zeleznyak St., Krasnoyarsk, 660022;
Pulmonologist, Pulmonology Department, 3a, Partizan Zeleznyak St., Krasnoyarsk, 660022
N. V. Gordeeva
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Krasnoyarsk Clinical Regional Hospital
Russian Federation
Russian Federation
Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy and Immunology with Postgraduate Education Course, Professor, 1, Partizan Zeleznyak St., Krasnoyarsk, 660022;
Pulmonologist, Pulmonology Department, 3a, Partizan Zeleznyak St., Krasnoyarsk, 660022
References
1. Fricke J., Ávila G., Keller T., Weller K., Lau S., Maurer M. et al. Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta-analysis. Allergy. 2020;75(2):423–432. https://doi.org/10.1111/all.14037.
2. Bulp M., Vietri J., Tian H., Isherwood G. The Impact of Chronic Urticaria from the Patient’s Perspective: A Survey in Five European Countries. Patient. 2015;8(6):551–558. https://doi.org/10.1007/s40271-015-0145-9.
3. Maurer M., Weller K., Bindslev-Jensen C., Giménez-Arnau A., J Bousquet P.J., Bousquet J. et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66(3):317–330. https://doi.org/10.1111/j.1398-9995.2010.02496.x.
4. Maurer M., Abuzakouk M., Bérard F., Canonica W., Oude Elberink H., Giménez-Arnauet A. et al. The burden of chronic spontaneous urticarial is substantial: Real-world evidence from ASSURE-CSU. Allergy. 2017;72(12):2005–2016. https://doi.org/10.1111/all.13209.
5. Kozel M.M.A., Sabroe R.A. Chronic urticaria: aetiology, management and current and future treatment options. Drugs. 2004;64(22):2515–2536. https://doi.org/10.2165/00003495-200464220-00003.
6. Fan H., Morand E.F. Targeting the side effects of steroid therapy in autoimmune diseases: the role of GILZ. Discov Med. 2012;13(69): 123–133. Available at: https://www.discoverymedicine.com/HuapengFan/2012/02/16/targeting-the-side-effects-of-steroid-therapy-inautoimmune-diseases-the-role-of-gilz.
7. Huscher D., Thiele K., Gromnica-Ihle E., Hein G., Demary W., Dreher R. et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009;68(7):1119–1124. https://doi.org/10.1136/ard.2008.092163.
8. . Khaitov R.M., Il’yina N.I. (eds.). Allergology and Clinical Immunology: Clinical Guidelines. Мoscow: GEHOTAR-Media; 2019. 352 p. (In Russ.) Available at: https://medknigaservis.ru/wp-content/uploads/2019/02/NF0013310.pdf.
9. Zuberbier T., Aberer W., Asero R., Abdul Latiff A.H., Baker D., BallmerWeber B. et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–1414. https://doi.org/10.1111/all.13397.
10. Sussman G., Abuzakouk M., Bérard F., Canonica W., Oude Elberink H., Giménez-Arnau A. et al. Angioedema in chronic spontaneous urticaria is underdiagnosed and has a substantial impact: Analyses from ASSURE‐ CSU Allergy. 2018;73(8):1724–1734. https://doi.org/10.1111/all.13430.
11. Kim B.R., Yang S., Choi J.W., Choi C.W., Youn S.W. Epidemiology and comorbidities of patients with chronic urticaria in Korea: a nationwide population-based study. J Dermatol. 2018;45(1):10–16. https://doi.org/10.1111/1346-8138.14075.
12. Schocket A.L. Chronic urticaria: pathophysiology and etiology, or the what and why. Allergy Asthma Proc. 2006;27(2):90−95. Available at: https://pubmed.ncbi.nlm.nih.gov/16724623.
13. Vonakis B.M., Saini S.S. New concepts in chronic urticarial. Curr Opin Immunol. 2008;20(6):709–716. https://doi.org/10.1016/j.coi.2008.09.005.
14. Maurer M., Eyerich K., Eyerich S., Ferrer M., Gutermuth J., Hartmann K. et al. Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol. 2020;181(5):321–333. https://doi.org/10.1159/000507218.
15. Kaplan A.P., Greaves M. Pathogenesis of chronic urticarial. Clin Exp Allergy. 2009;39:777–787. https://doi.org/10.1111/j.1365-2222.2009.03256.x.
16. Bracken S.J., Abraham S., MacLeod A.S. Autoimmune Theories of chronic spontaneous urticaria. Front Immunol. 2019;10:627. https://doi.org/10.3389/fimmu.2019.00627.
17. Schmetzer O., Lakin E., Topal F.A., Preusse P., Freier D., Church M.K., Maurer M. IL-24 is a common and specific autoantigen of IgE in patients with chronic spontaneous urticaria. J Allergy Clin Immunol. 2018;142(3):876–882. https://doi.org/10.1016/j.jaci.2017.10.035.
18. Altrichter S., Peter H.J., Pisarevskaja D., Metz M., Martus P., Maureret M. IgE mediated autoallergy against thyroid peroxidase — a novel pathomechanism of chronic spontaneous urticaria? PLoS ONE. 2011;6(4):e14794. https://doi.org/10.1371/journal.pone.0014794.
19. Sánchez J., Sánchez A., Cardona R. Causal relationship between anti-TPO IgE and chronic urticaria by in vitro and in vivo tests. Allergy Asthma Immunol Res. 2019;11(1):29–42. https://doi.org/10.4168/aair.2019.11.1.29.
20. Hatada Y., Kashiwakura J., Hayama K., Fujisawa D., Sasaki-Sakamoto T., Terui T. et al. Significantly high levels of anti-dsDNA immunoglobulin E in sera and the ability of dsDNA to induce the degranulation of basophils from chronic urticaria patients. Int Arch Allergy Immunol. 2013;161(2): 154–158. https://doi.org/10.1159/000350388.
21. Cugno M., Asero R., Ferrucci S., Lorini M., Carbonelli V., Tedeschi A., Marzano A.V. Elevated IgE to tissue factor and thyroglobulin are abated by omalizumab in chronic spontaneous urticaria. Allergy. 2018;73(12):2408–2411. https://doi.org/10.1111/all.13587.
22. Shankar T., Petrov A. Omalizumab and hypersensitivity reactions. Curr Opin Allergy Clin Immunol. 2013;13(1):19–24. https://doi.org/10.1097/ACI.0b013e32835bf3f5.
23. Metz M., Maurer M. Omalizumab in chronic urticarial. Curr Opin Allergy Clin Immunol. 2012;12(4):406–411. https://doi.org/10.1097/ACI.0b013e328355365a.
24. Romano C., Sellitto A., Fanis U.D., Balestrieri A., Savoia A., Abbadessa S. et al. Omalizumab for difficult-to-treat dermatological conditions: clinical and immunological features from a retrospective real-life experience. Clin Drug Investig. 2015;35(3):159–168. https://doi.org/10.1007/s40261-015-0267-9.
25. Prussin C., Griffith D.T., Boesel K.M., Lin H., Foster B., Casale T.B. Omalizumab treatment downregulates dendritic cell FcepsilonRI expression. J Allergy Clin Immunol. 2003;112(6):1147–1154. https://doi.org/10.1016/j.jaci.2003.10.003.
26. Beck L.A., Marcotte G.V., MacGlashan D., Togias A., Saini S. Omalizumab-induced reductions in mast cell Fce psilon RI expression and function. J Allergy Clin Immunol. 2004;114(3):527–530. https://doi.org/10.1016/j.jaci.2004.06.032.
27. Kaplan A., Ledford D., Ashby M. Canvin J., Zazzali J.L., Conner E. et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticarial despite standard combination therapy. J Allergy Clin Immunol. 2013;132(1):101–109. https://doi.org/10.1016/j.jaci.2013.05.013.
28. Maurer M., Rosén K., Hsieh H.J., Saini S., Grattan C., Gimenéz-Arnau A. et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–935. https://doi.org/10.1056/ NEJMoa1215372.
29. Zhao Z.-T., Ji C.-M., Yu W.-J., Meng L., Hawro T., Wei J.-F., Maurer M. Omalizumab for the treatment of chronic spontaneous urticaria: a metaanalysis of randomized clinical trials. J Allergy Clin Immunol. 2016;137(6):1742–1750. https://doi.org/10.1016/j.jaci.2015.12.1342.
30. Tharp M.D., Bernstein J.A., Kavati A., Ortiz B., MacDonald K., Denhaerynck K. et al. Benefits and harms of omalizumab treatment in adolescent and adultpatients with chronic idiopathic (spontaneous) urticaria: a metaanalysis of “real-world” evidence. JAMA Dermatol. 2019;155(1):29–38. https://doi.org/10.1001/jamadermatol.2018.3447.
31. Yoo B., Bernstein J.A. Impact of omalizumab on patient-reported outcomes in chronic idiopathic urticaria: Results from a randomized study (XTENDCIU). J Allergy Clin Immunol Pract. 2019;7(7):2487–2490.e1. https://doi.org/10.1016/j.jaip.2019.04.020.
Review
For citations:
Sobko EA, Demko IV, Shestakova NA, Kraposhina AY, Gordeeva NV. Experience of long-term use of anti-IgE therapy in a patient with chronic spontaneous urticarial. Meditsinskiy sovet = Medical Council. 2022;(6):176-180. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-6-176-180
Views:
406
Email this article 