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Case Report

 

Severe Anaphylaxis to Bee Venom Immunotherapy: Efficacy of Pretreatment and Concurrent Treatment With Omalizumab

 

C Galera,1 N Soohun,1 N Zankar,1 S Caimmi,1 C Gallen,2 P Demoly1

1Allergy and Respiratory Diseases Unit, H˘pital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
2 Allergy Unit, Narbonne Hospital, Narbonne, France

J Investig Allergol Clin Immunol 2009; Vol. 19(3): 225-229

 

 Abstract


Immunotherapy is an established mode of treatment for Hymenoptera venom anaphylaxis, although adverse reactions may occur.
We report the case of a 33-year-old woman, the wife of a beekeeper, who experienced a systemic allergic reaction following a bee sting.
Initial specific immunotherapy had to be stopped due to anaphylaxis (multiple immediate cardiovascular reactions).
We looked for an alternative treatment option, and repeated immunotherapy accompanied by the anti-immunoglobulin (Ig) E monoclonal antibody omalizumab. Our new protocol was well tolerated.
After 1 year of therapy, the patient was stung by a bee and developed only a slight local reaction, which resolved spontaneously. This result confirmed the success of our specific immunotherapy. We compared our results with those of 6 similar cases in the literature. Anti-IgE has provided a treatment option for patients with severe IgE-mediated allergic disease that is difficult to treat. This case suggests that omalizumab may be able to prevent anaphylaxis during immunotherapy.

Key words: Bee venom allergy. Omalizumab. Immunotherapy.