Vaccaro Mario, Marafioti Ilenia, Cannavò Serafinella Patrizia, Ciccarese Giulia, Drago Francesco
Department of Clinical and Experimental Medicine-Dermatology, University of Messina, Messina, Italy.
Dermatology Unit, Ospedale Policlinico San Martino, Genoa, Italy.
Dermatol Ther. 2020 Nov;33(6):e14356. doi: 10.1111/dth.14356. Epub 2020 Oct 10.
Pityriasis rosea (PR) is an exanthematous disease whose etiology is related to reactivation of herpes human herpesviruses 6 (HHV-6) and 7 (HHV-7). We observed two cases of PR arising during omalizumab therapy for chronic spontaneous urticaria (CSU). Here we report for the first time PR occurring during omalizumab treatment. After PR diagnosis, viral serology was performed. Data in literature about omalizumab mechanism of action, PR and HHV-6/7 infection were analyzed in order to identify possible correlations. In both our cases IgM against HHV-6 and HHV-7 were negative. The first patient presented altered IgG titers for both viruses (1:160 and 1:80, respectively) while only HHV-6 IgG (1:320) were detected in the second patient. From data in literature, we consider it presumable that apoptotic immune cells due to omalizumab immunomodulation could release viral proteins produced from integrated DNA. This could elicit cutaneous cross-reactivity and PR onset. In conclusion, we think there is a link between omalizumab therapy and PR occurring in patients with CSU. Our case history is too small to draw firm conclusions. Data collection of similar cases could be helpful to improve our knowledge.
玫瑰糠疹（PR）是一种发疹性疾病，其病因与人类疱疹病毒6型（HHV - 6）和7型（HHV - 7）的重新激活有关。我们观察到两例在使用奥马珠单抗治疗慢性自发性荨麻疹（CSU）期间出现的PR病例。在此我们首次报告奥马珠单抗治疗期间发生的PR。PR诊断后，进行了病毒血清学检测。分析了文献中关于奥马珠单抗作用机制、PR和HHV - 6/7感染的数据，以确定可能的相关性。在我们的两个病例中，针对HHV - 6和HHV - 7的IgM均为阴性。第一位患者两种病毒的IgG滴度均有改变（分别为1:160和1:80），而第二位患者仅检测到HHV - 6 IgG（1:320）。从文献数据来看，我们推测由于奥马珠单抗的免疫调节作用导致凋亡的免疫细胞可能释放整合DNA产生的病毒蛋白。这可能引发皮肤交叉反应和PR发病。总之，我们认为奥马珠单抗治疗与CSU患者发生的PR之间存在联系。我们的病例数量太少，无法得出确凿结论。收集类似病例的数据可能有助于增进我们的认识。
