Iemoli E, Niero F, Borgonovo L, Cossu M V, Piconi S
Allergy and Clinical Immunology and 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy.
Allergy and Clinical Immunology and 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy. E-mail:
Eur Ann Allergy Clin Immunol. 2017 Mar;49(2):88-91.
We described a case of a 56 year old homosexual HIV positive man who presented a history of CSU since one year (2012). All the allergologic, immunologic and microbiologic tests to evaluate the pathogenesis of wheals resulted negative. Therefore in June 2015 we decided to start therapy with Omalizumab while the patient kept on effective antiretroviral therapy with 310 cells/mm3 TCD4 counts and undetectable HIV viremia. After two monthly subcutaneuous injection of 150 mg of Omalizumab the patient had no more urticarial symptoms. UAS7 (Urticaria Activity Score over 7 days) and Cu-Q2oL (chronic urticarial quality of life questionnaire) dropped respectively to 14 from 42 and to 0 from 40 with increase of TCD4 counts while viral load remained undetectable. In November 2015, i.e. 4 months after the end of Omalizumab therapy, the patient was still asymptomatic with persistent effective immune-virological response to antiretroviral therapy. This case report confirms the excellent tolerability and efficacy of anti-IgE therapy in the treatment of spontaneous chronic urticarial even in an immunodepressed patient for HIV infection. Omalizumab therapy shows a remarkable clinical success and had no effect on peripheral TCD4 counts and HIV viral load.
我们描述了一例56岁的同性恋HIV阳性男性病例，该患者自2012年起有慢性自发性荨麻疹（CSU）病史。所有用于评估风团发病机制的变态反应学、免疫学和微生物学检查结果均为阴性。因此，在2015年6月，我们决定开始使用奥马珠单抗进行治疗，此时患者持续接受有效的抗逆转录病毒治疗，TCD4细胞计数为310个/mm³，HIV病毒血症检测不到。在每月皮下注射两次150mg奥马珠单抗后，患者不再有荨麻疹症状。7天荨麻疹活动评分（UAS7）和慢性荨麻疹生活质量问卷（Cu-Q2oL）分别从42降至14，从40降至0，同时TCD4细胞计数增加，而病毒载量仍检测不到。2015年11月，即奥马珠单抗治疗结束4个月后，患者仍无症状，对抗逆转录病毒治疗持续有有效的免疫病毒学反应。本病例报告证实了抗IgE治疗在治疗自发性慢性荨麻疹方面具有良好的耐受性和疗效，即使是在一名因HIV感染而免疫抑制的患者中也是如此。奥马珠单抗治疗显示出显著的临床成功，且对外周TCD4细胞计数和HIV病毒载量没有影响。
