D3.427 - Challenging the paradigm: Use of omalizumab in refractory angioedema in a 2-year-old child

Introduction

Urticaria is characterized by the appearance of wheal-like lesions, which are itchy, accompanied by angioedema, or both. It can be classified according to its duration as acute or chronic, with chronic urticaria lasting more than 6 weeks. When angioedema is the only symptom of chronic urticaria, other pathologies should be ruled out, such as hereditary angioedema, autoimmune diseases, mast cell activation, etc.

In pediatric patients, there are few studies on the treatment of difficult-to-manage chronic urticaria. That's why we present the case of a 2-year-old patient with recurrent angioedema of several months' duration, who responded poorly to conventional therapies.

Abstract

We present a male patient, 1 year and 4 months old at the time of his first evaluation, who was referred for recurrent angioedema of 6 months' duration, which began after a bee sting that triggered anaphylaxis. These episodes showed little to no response to antihistamines and lasted 2 to 4 days. Hereditary angioedema, mastocytosis, and other immune diseases were ruled out. The patient was sensitized to bees (Api m 1 0.3 kUA/L), with a history of previous anaphylaxis. Angioedema episodes persisted even with high doses of antihistamines (Four-fold up-dosing) and the use of immunosuppressants (ciclosporine, mycophenolate mofetil), having better results with ebastine, but episodes still persisted. Because of this, at 2 years of age, omalizumab was initiated, achieving remission of episodes by the 4th month of treatment. Treatment was discontinued after 6 months, and there were no subsequent relapses.

Conclusions: 

The use of omalizumab is authorized for patients over 12 years of age in chronic urticaria, however in children younger than this age it may be useful in refractory cases.