특발성 아나필락시스 환자에서 오말리주맙의 치료 효과
Favorable outcome of omalizumab treatment in a patient with idiopathic anaphylaxis
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Anaphylaxis is a severe and life-threatening systemic reaction. Despite the extensive evaluation to determine the cause, 30%–60% of cases of anaphylaxis in adults remain idiopathic. Recently, omalizumab treatment has been postulated to treat refractory idiopathic anaphylaxis. We report a case of idiopathic anaphylaxis treated with omalizumab and investigated its pharmacological mechanism. A 66-year-old female presented to our clinic with recurrent anaphylaxis. She suffered from anaphylaxis 2–3 times a month for 6 months. She had past medical history of nonallergic bronchial asthma. History was carefully undertaken and anaphylaxis was not related to any specific foods, drugs, exercise, and insect bites. Serum specific IgE antibodies to common food allergens showed negative results. Oral provocation tests to food additives revealed to be negative. To screen systemic mastocytosis and mast cell activating syndrome, baseline tryptase level was checked, and it was within normal range. From comprehensive evaluation, she was diagnosed as having idiopathic anaphylaxis. She could not tolerate oral medications due to gastrointestinal discomfort, therefore, omalizumab treatment (150 mg, monthly) was started. After 6 months of treatment, anaphylaxis did not occur with complete remission status. To evaluate the pharmacological mechanism of omalizumab treatment, basophil histamine releasability test was performed. Histamine releasability induced by anti-IgE did not change after 6 months of treatment, while that induced by calcium inophore decreased. Omalizumab treatment can induce remission or favorable effects on idiopathic anaphylaxis, which may be derived from increased threshold of mast cell degranulation. Long-term studies in a larger cohort will be needed to confirm its efficacy.
Abstract
Anaphylaxis is a severe and life-threatening systemic reaction. Despite the extensive evaluation to determine the cause, 30%–60% of cases of anaphylaxis in adults remain idiopathic. Recently, omalizumab treatment has been postulated to treat refractory idiopathic anaphylaxis. We report a case of idiopathic anaphylaxis treated with omalizumab and investigated its pharmacological mechanism. A 66-year-old female presented to our clinic with recurrent anaphylaxis. She suffered from anaphylaxis 2–3 times a month for 6 months. She had past medical history of nonallergic bronchial asthma. History was carefully undertaken and anaphylaxis was not related to any specific foods, drugs, exercise, and insect bites. Serum specific IgE antibodies to common food allergens showed negative results. Oral provocation tests to food additives revealed to be negative. To screen systemic mastocytosis and mast cell activating syndrome, baseline tryptase level was checked, and it was within normal range. From comprehensive evaluation, she was diagnosed as having idiopathic anaphylaxis. She could not tolerate oral medications due to gastrointestinal discomfort, therefore, omalizumab treatment (150 mg, monthly) was started. After 6 months of treatment, anaphylaxis did not occur with complete remission status. To evaluate the pharmacological mechanism of omalizumab treatment, basophil histamine releasability test was performed. Histamine releasability induced by anti-IgE did not change after 6 months of treatment, while that induced by calcium inophore decreased. Omalizumab treatment can induce remission or favorable effects on idiopathic anaphylaxis, which may be derived from increased threshold of mast cell degranulation. Long-term studies in a larger cohort will be needed to confirm its efficacy.
참고문헌 (14)
- Wood RA, "Anaphylaxis in America : the prevalence and characteristics of anaphylaxis in the United States", J Allergy Clin Immunol, 133, pp.461~467 (2014)
- 예영민, "Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study", Allergy, Asthma & Immunology Research, 7(1), pp.22~29 (2015), 대한천식알레르기학회
- Greenberger PA, "Idiopathic anaphylaxis", Immunol Allergy Clin North Am, 27, pp.273~293 (2007)
- Lieberman P, "The diagnosis and management of anaphylaxis practice parameter:2010 update", J Allergy Clin Immunol, 126, pp.477~480.e1-42 (2010)
- Jones JD, "Idiopathic anaphylaxis successfully treated with omalizumab", Ann Allergy Asthma Immunol, 101, pp.550~551 (2008)
- Demirturk M, "Promising option in the prevention of idiopathic anaphylaxis : omalizumab", J Dermatol, 39, pp.552~554 (2012)
- Warrier P, "Omalizumab in idiopathic anaphylaxis", Ann Allergy Asthma Immunol, 102, pp.257~258 (2009)
- 김수정, "A Case of Idiopathic Anaphylaxis Followed by Acute Liver Injury", Allergy, Asthma & Immunology Research, 5(4), pp.245~247 (2013), 대한천식알레르기학회
- Hur GY, "Histamine release and inflammatory cell infiltration in airway Mucosa in methylene diphenyl diisocyanate(MDI)-induced occupational asthma", J Clin Immunol, 28, pp.571~580 (2008)
- Wong S, "Outcome of prophylactic therapy for idiopathic anaphylaxis", Ann Intern Med, 114, pp.133~136 (1991)
- Normansell R, "Omalizumab for asthma in adults and children", Cochrane Database Syst Rev, 1, pp.CD003559~ (2014)
- Gevaert P, "Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma", J Allergy Clin Immunol, 131, pp.110~116.e1 (2013)
- Zuberbier T, "The EAACI", GA(2) LEN, WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update, pp.Allergy, 2014[DOI]
- Chang TW, "Anti-IgE as a mast cell-stabilizing therapeutic agent", J Allergy Clin Immunol, 117, pp.1203~1212 (2006)