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Anaphylaxis due to food-related anaphylaxis treated with omalizumab

Hui Chien Lai, Kuan-Hua Chu, Su-Boon Yong

Anaphylaxis is a systemic allergic reaction that is acute and could be life-threatening. Once diagnosed, avoidance of allergen and carrying an epinephrine auto-injector are recommended. Most anaphylactic reactions are immunoglobulin E (IgE)-mediated and the major triggers include food, medication, insect stings, exercise and vaccines. Here, we present a case of a 38-year-old male, a surgeon, diagnosed as food-related anaphylaxis with a convincing clinical history and the positive serum-specific IgE level to Dermatophagoides pteronyssinus and Dermatophagoides farina allergens. This patient was treated with omalizumab administered subcutaneously. Routine lymphocyte subsets and CD23+ B cells of this patient were evaluated monthly for the consecutive ten months and one year after the last treatment. Our data showed that there was a correlation between the level of CD23+ B cells and the efficacy of omalizumab treatment. The patient had higher percentage of CD23+ B cells and CD23 expression level (86.5 % and MFI 371.9, respectively) during the onset of anaphylaxis. With the omalizumab treatment, both CD23+ B cells and CD23 expression level decreased gradually. The basal levels of CD23+ B cells and CD23 expression dropped to 25.1% and 72.6 MFI, respectively when the patient became recovered one year after the last treatment. Our findings highlight the potential of CD23+ B cells to be the useful parameter to predict the treatment effect of omalizumab in food-related anaphylaxis.