PDF(Pubmed)
Abstract：
Omalizumab, a humanized anti-IgE monoclonal antibody, is commonly employed in the treatment of antihistamine-refractory chronic spontaneous urticaria (CSU), where it significantly reduces free IgE levels, minimizing histamine release from basophils and mast cells. Despite its efficacy, there are concerns regarding its effect on parasitic defense due to IgE\'s role in combating parasitic infestations. We present a case of a 28-year-old female agriculturist with a six-month history of CSU who experienced a paradoxical exacerbation of her symptoms following an increase in the omalizumab treatment dose. This deterioration coincided with a serologically confirmed parasitic infection with Echinococcus granulosus and Toxocara canis. Despite normal eosinophil counts and IgE levels, which are typically used to identify parasitic infections, the patient\'s clinical worsening prompted further investigation that led to the identification of the parasitic infection. Treatment with albendazole and omalizumab discontinuation led to the resolution of her CSU, suggesting that the parasitic infection was contributing to the symptom exacerbation. This case highlights the need for careful screening for parasitic infections before initiating omalizumab in antihistamine-refractory CSU patients from endemic regions, or patients who deteriorate clinically on omalizumab, especially when other indicators such as eosinophil count and IgE levels might not suggest infection. It also underscores the importance of considering a tailored approach to managing CSU that balances effective treatment with the potential for adverse effects related to immunomodulation.
摘要：
奥马珠单抗,人源化抗IgE单克隆抗体，通常用于治疗抗组胺难治性慢性自发性荨麻疹（CSU），它显著降低了游离IgE水平，减少从嗜碱性粒细胞和肥大细胞释放组胺。尽管它的功效,由于IgE在抵抗寄生虫侵染中的作用，人们担心其对寄生虫防御的影响。我们介绍了一名28岁的女性农学家，有六个月的CSU病史，在奥马珠单抗治疗剂量增加后，她的症状出现了矛盾的恶化。这种恶化与血清学证实的细粒棘球蚴和犬弓形虫寄生虫感染同时发生。尽管嗜酸性粒细胞计数和IgE水平正常,通常用于识别寄生虫感染，患者的临床恶化促使进一步的调查，从而确定了寄生虫感染。阿苯达唑和奥马珠单抗停药治疗导致她的CSU消退，这表明寄生虫感染是导致症状恶化的原因。该病例强调了在对来自流行地区的抗组胺难治性CSU患者开始奥马珠单抗之前，需要仔细筛查寄生虫感染。或奥马珠单抗临床恶化的患者，尤其是当嗜酸性粒细胞计数和IgE水平等其他指标可能不提示感染时.它还强调了考虑采用量身定制的方法来管理CSU的重要性，该方法应平衡有效治疗与与免疫调节相关的潜在不良反应。
