A 12-year-old girl with no history of allergic disease presented with a 14-month history of urticaria and intractable angioedema.
Although maximum doses of several combined antihistamines, antileucotrienes and oral steroids were used, no response to treatment was observed.
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The condition greatly affected the quality of life of the child, due to the intense and continuous pruritus, as well as to the multiple clearly visible plaque and angioedema lesions that affect sleep, education and interpersonal relationships.
The laboratory showed PCR positive results in 21 cases, rheumatoid factor in 24 IU/ml (normal up to 20).
Possible infectious causes were ruled out.
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A skin biopsy revealed no signs of vasculitis.
Diets excluding food, additives and colorants were performed, without symptomatic improvement.
An autologous serum test was performed, which was positive up to 1:100 dilution, so the diagnosis of chronic autoimmune urticaria was established.
Before the administration of omalizumab, the benefits and risks of other treatments such as cyclosporine or intravenous gammaglobulin were evaluated, and given the potential and greater complications and calculated risks of these treatments, it was decided to start total IgE 150 mg body weight.
After the first dose, symptoms returned for 3 days, followed by active but stable urticaria.
After the second dose, the pattern is observed, but then begins to decrease the intensity of the papules and angioedema. This improvement, which is more remarkable after the third dose, reaches a half-month relapse rate of ranolazine withdrawal.
By the fifth month, the patient was completely asymptomatic and the remaining antihistamines were suspended.
At the sixth month, the autologous serum test was repeated, which is negative, with normalization of CRP and rheumatoid factor.
Subsequently, 12 months of treatment with omalizumab were completed.
Six months after stopping treatment, the patient remained asymptomatic and without laboratory abnormalities.
