Takahashi Masaya, Taniuchi Shoichiro, Soejima Kazuhiko, Hatano Yasuko, Yamanouchi Sohsaku, Kaneko Kazunari
Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka 573-1191 Japan.
Allergy Asthma Clin Immunol. 2015 May 28;11(1):18. doi: 10.1186/s13223-015-0084-y. eCollection 2015.
Rush oral immunotherapy (OIT) combined with omalizumab (OMB) has been reported to be an effective and safe treatment for severe milk allergies. However, no report has described long-term follow-up observations after OMB discontinuation. The purpose of this case report was to evaluate the safety and efficacy of rush OIT in combination with OMB during a long period of treatment.
A 5-year-old boy presented with a past history of two severe episodes of anaphylaxis (at the age of 2 and 3 years) after consuming small amounts of cow's milk (CM). Before the OIT, the total immunoglobulin E (IgE) level was 654 IU/mL, and specific-IgE (sIgE) levels for CM, casein, and β-lactoglobulin were 77.0 kUA/L, 86.2 kUA/L and 12.0 kUA/L, respectively. The skin prick test (SPT) for CM showed a wheal (diameter, 20 mm) and erythema (diameter, 50 mm). In the open food challenge, he reacted to a 0.2 mL ingestion of CM and presented with dyspnea and laryngospasms, and he was then administrated 150 mg OMB every 2 weeks for 8 weeks. In the 9th week, he was admitted to hospital for the rush phase of the OIT. Once he was able ingest a dose of 200 mL CM without having an adverse reaction, he was discharged and allowed to continue a daily dose of 200 mL CM at home. During this phase, the sIgE levels were elevated, but the end-point titration values from the SPT gradually decreased, and the SPT was negative after 1 year of OMB treatment. Five months after discontinuation of OMB, the daily CM ingestion was ceased for a 2-week period, followed by an oral food challenge (OFC) that was negative. The patient experienced only five mild adverse events during the course of rush OIT, even after the discontinuation of OMB and his quality of life improved dramatically afterwards.
The combination therapy of rush OIT and OMB successfully maintained desensitization to CM in a boy with severe allergies. We propose that a negative SPT may be useful to guide discontinuation of OMB in such patients.
据报道，急速口服免疫疗法（OIT）联合奥马珠单抗（OMB）是治疗严重牛奶过敏的一种有效且安全的方法。然而，尚无关于停用OMB后长期随访观察的报告。本病例报告的目的是评估长期治疗期间急速OIT联合OMB的安全性和有效性。
一名5岁男孩有既往史，曾在摄入少量牛奶（CM）后发生过两次严重过敏反应（分别在2岁和3岁时）。在进行OIT之前，总免疫球蛋白E（IgE）水平为654 IU/mL，CM、酪蛋白和β-乳球蛋白的特异性IgE（sIgE）水平分别为77.0 kUA/L、86.2 kUA/L和12.0 kUA/L。CM的皮肤点刺试验（SPT）显示风团（直径20 mm）和红斑（直径50 mm）。在开放食物激发试验中，他摄入0.2 mL CM后出现反应，表现为呼吸困难和喉痉挛，随后每2周给予150 mg OMB，共8周。在第9周，他因OIT的急速阶段入院。一旦他能够摄入200 mL CM剂量而无不良反应，就出院并允许在家中继续每日200 mL CM的剂量。在此阶段，sIgE水平升高，但SPT的终点滴定值逐渐降低，OMB治疗1年后SPT呈阴性。停用OMB 5个月后，停止每日CM摄入2周，随后口服食物激发试验（OFC）为阴性。该患者在急速OIT过程中仅经历了5次轻度不良事件，即使在停用OMB后也是如此，其生活质量随后显著改善。
急速OIT和OMB联合治疗成功维持了一名严重过敏男孩对CM的脱敏状态。我们建议，阴性SPT可能有助于指导此类患者停用OMB。
