case_images: PMC6881985_01
case_images: PEF level of the patient. The upper and lower bounds of the line represent the range of PEF change during the OPD follow-up period, and the square mark in the middle of the line represents the average maximum and minimum values of PEF during the period. Triangle marks represent the maximum PEF during the period on 2017/03/31, 2018/08/29, 2018/10/24. 2017/05/-2017/08 omalizumab use; 2017/09-2017/10 omalizumab desensitization; 2017/12/18 upper airway infection; 2018/05/07 LLL pneumonia; 2018/07/24 resume omalizumab use. PEF peak expiratory flow
case_images: 13223_2019_378_Fig1_HTML.jpg
case_images: PMC6881985_01_13223_2019_378_Fig1_HTML.jpg
case_images: Fig1
case_images: However, pruritic small erythematous papules developed over her trunk and extremities 2 weeks after the fourth injected dose of omalizumab (Additional file 2: Figure S1). Her peak expiratory flow (PEF) value declined to around 100 to 150 L per minute (Fig. 1), and she became OCS-dependent for symptom control even after the pneumonia was resolved.
case_images: Immunohistochemistry staining of bronchial epithelium for the patient. a Significant IgE-positive epithelium cells in the specimen, indicating a strong IgE-mediate immune reaction in the patient's airway. b Weak positive staining of IL-5 in the submucosal area
case_images: 13223_2019_378_Fig2_HTML.jpg
case_images: PMC6881985_01_13223_2019_378_Fig2_HTML.jpg
case_images: Fig2
case_images: The patient underwent a right-thigh skin biopsy by dermatologist, the results of which were consistent with maculopapular drug eruption (Additional file 2: Figure S2). The immunohistochemical staining (Fig. 2) showed strongly positive staining of IgE over airway epithelium cells and only weakly positive immunohistochemical staining of IL-5 over the sub-mucosal area.