Title:Real-life Experience of Clinical Efficacy of Omalizumab Use in the MiddleEast: Should We Also Be Concerned About Parasites?
VOLUME: 2 ISSUE: 1
Author(s):Carla Irani and Olga Nahas
Affiliation:Hotel Dieu de France hospital, Saint Joseph University, Beirut, Lebanon.
Keywords:Asthma, eosinophils, nasal polyposis, omalizumab, prasites, urticaria.
Abstract:Background: Omalizumab is a monoclonal anti-IgE antibody approved for the treatment of
severe allergic asthma. There is increasing evidence in the literature of its usefulness in other allergic
conditions such as chronic urticaria and nasal polyposis. Methods: Here in, we report a prospective
case series of 52 adult patients in a tertiary university hospital, Allergy and Immunology Clinic: 36
with severe asthma, among them 6 with associated nasal polyposis, 2 with associated hypereosinophilia
in the range of 25% not explained by other etiologies, and one had associated atopic dermatitis.
Fourteen with chronic urticaria (CU) and two with isolated nasal polyposis were also treated with
Omalizumab. The dose given for severe asthma and nasal polyposis was according to the dosing chart of weight and total
IgE. The dose given for severe asthma and nasal polyposis was according to the dosing chart of weight and total IgE. The
dose given for chronic urticaria was 300mg SC every 4 weeks. We assessed the clinical benefits after 6 and 12 months of
treatment. We also evaluated clinical improvement and side effects in particular incidence of parasitic infections. Faeces
sampling were undertaken at baseline and during the treatment period only if symptoms occur. Results: After 6 months of
treatment, 32 asthmatic patients had major improvement, four patients had partial improvement but all of them stopped
oral corticosteroids. Ten patients had complete remission of chronic urticaria off any medication, three had partial improvement
withdrawing steroids but still requiring anti-histamines, and one patient had no response and stopped Omalizumab
at 6 months. Patients with nasal polyposis stopped nasal steroids and recovered the sense of olfaction after 6
months of therapy and completed one year of treatment. There was no effect in the case of the patient with atopic dermatitis.
The major improvement noted after 6 months of treatment persisted at 1 year of follow up. Two patients (4%) developed
pneumonia after the third month of treatment, eight patients (15%) developed fatigue and mild pain in lower extremities
on the day of injections, four patients (8%) had mild shortness of breath with 40 minutes of surveillance treated
with 2 puffs of ventolin. Only one patient (1/52 or 2%) had an active parasitic infection EntamoebaHistolytica detected after
diarrhea, pruritis and acute eosinophilia, during the third month of treatment with Omalizumab, requiring treatment.
Conclusion: This is the first case series study done in Lebanon. The efficacy and incidence of side effects is consistent
with other recently published series and studies. Despite a prevalence of 12.4% of intestinal parasites in the Lebanese
population, the incidence of parasitic infections in our population receiving Omalizumab was not significant (p>0.05).
