Anne Ari1, Yael Levy1,2, Nirit Segal1, Ramit Maoz-Segal3, Shira Benor2,4, Arnon Broides5,6, Amir Horev7,6, Na'ama Epstein-Rigbi8, Nancy Agmon-Levin2,3, Nufar Marcus1,2. 1. Kipper Institute of Immunology and Allergy, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune diseases, Sheba Medical Center, Tel Hashomer, Israel. 4. Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel. 5. Pediatric Immunology Clinic, Soroka University Medical Center & Faculty of Health Services, Ben-Gurion University of the Negev, Beer Sheva, Israel. 6. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 7. Pediatric Dermatology Services, Soroka University Medical Center & Faculty of Health Services, Ben-Gurion University of the Negev, Beer Sheva, Israel. 8. Institute of Allergy, Immunology, and Paediatric Pulmonology, Yitzhak Shamir Medical Centre, Beer Yaakov, Israel.
Abstract
BACKGROUND: Chronic urticaria is defined by the presence of itchy wheals, sometimes accompanied by angioedema, lasting for at least 6 weeks. In children, most cases occur without an eliciting factor and are defined as chronic spontaneous urticaria (CSU). CSU affects up to 0.75% of children with a negative impact on quality of life and school performance. CSU is treated in adults with second-generation antihistamines, increased up to four times normal doses for second-line treatment. Omalizumab (a monoclonal antibody to IgE) may be recommended as third-line therapy. A similar protocol is used in children, yet little is known of its efficacy and safety. OBJECTIVES: To summarize our multi-center experience in treating children with recalcitrant CSU with omalizumab. METHODS: A retrospective multi-center case series conducted in 5 tertiary care centers in Israel. Patients included were children <18 years old diagnosed with recalcitrant CSU who were treated with omalizumab. Patients were followed up throughout the duration of omalizumab therapy/symptom remission. Patients' electronic medical records were used to gather data. RESULTS: Nineteen participants (11 F; 8 M) presented with CSU between ages 6 and 16.9 years. Sixteen (84%) responded to omalizumab, including children <12 years old, although two became non-responsive after 6-12 months of therapy. Another three patients (16%) were resistant to treatment, achieving remission through fourth-line (Cyclosporine A) or other therapies. CONCLUSION: Children with recalcitrant CSU, even those <12 years old, respond well to standard-dose, third-line omalizumab therapy at rates similar to adults. Yet, some cases may become non-responsive with ongoing treatment.
BACKGROUND:Chronic urticaria is defined by the presence of itchy wheals, sometimes accompanied by angioedema, lasting for at least 6 weeks. In children, most cases occur without an eliciting factor and are defined as chronic spontaneous urticaria (CSU). CSU affects up to 0.75% of children with a negative impact on quality of life and school performance. CSU is treated in adults with second-generation antihistamines, increased up to four times normal doses for second-line treatment. Omalizumab (a monoclonal antibody to IgE) may be recommended as third-line therapy. A similar protocol is used in children, yet little is known of its efficacy and safety. OBJECTIVES: To summarize our multi-center experience in treating children with recalcitrant CSU with omalizumab. METHODS: A retrospective multi-center case series conducted in 5 tertiary care centers in Israel. Patients included were children <18 years old diagnosed with recalcitrant CSU who were treated with omalizumab. Patients were followed up throughout the duration of omalizumab therapy/symptom remission. Patients' electronic medical records were used to gather data. RESULTS: Nineteen participants (11 F; 8 M) presented with CSU between ages 6 and 16.9 years. Sixteen (84%) responded to omalizumab, including children <12 years old, although two became non-responsive after 6-12 months of therapy. Another three patients (16%) were resistant to treatment, achieving remission through fourth-line (Cyclosporine A) or other therapies. CONCLUSION:Children with recalcitrant CSU, even those <12 years old, respond well to standard-dose, third-line omalizumab therapy at rates similar to adults. Yet, some cases may become non-responsive with ongoing treatment.
Authors: Paolo Del Barba; Federica Del Tedesco; Giulio Frontino; Maria Pia Guarneri; Riccardo Bonfanti; Graziano Barera Journal: Front Immunol Date: 2022-04-12 Impact factor: 8.786
Authors: Amelia Licari; Sara Manti; Salvatore Leonardi; Domenico Minasi; Carlo Caffarelli; Fabio Cardinale; Michele Miraglia Del Giudice; Mauro Calvani; Giorgio Ciprandi; Gian Luigi Marseglia Journal: Acta Biomed Date: 2021-11-29