Tobias Rogosch - Plasmapheresis prior to omalizumab administration in a 15-year-old boy with severe asthma and very high IgE levels: sustained effect over 2 years.

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  Publication Details (including relevant citation   information):

  Kerzel S, Zemlin M, Rogosch T, Ollert M, Renz H, Klaus G, Maier   RF

  Klin   Padiatr. 2011 Nov;223(6):356-9.

  doi: 10.1055/s-0031-1287824



  Anti-IgE therapy with omalizumab is an innovative therapy option   in patients with severe allergic asthma. However, many patients   are excluded from this treatment due to very high serum IgE   levels which lie above the weight-dependent cut-off for a   reasonable omalizumab administration (700 kU/l).


  We sought to evaluate whether a preceding plasma exchange is   suitable to establish the starting basis for a subsequent   anti-IgE therapy in a 15 year-old boy with steroid-resistant   unstable allergic asthma whose pretreatment serum IgE levels   ranged between 3 000 and 8 000 kU/l.


  Our aim was to create a period with relatively low IgE serum   concentrations, which could be overridden by a high dose of   omalizumab. 3 sessions of plasmapheresis were performed and   3×3 000 ml plasma were exchanged against albumin solution.


  We removed an absolute amount of 8 650 kU total IgE. During   plasmapheresis, serum IgE levels markedly declined and fell below   500 kU/l. Immediately after the third plasma exchange, we started   omalizumab therapy. As expected, total IgE levels began to rise   again upon cessation of plasmapheresis, and after 2 months the   pre-treatment values were reached. In contrast, serum   concentrations of free IgE remained stable on a level of about   80 kU/l during the whole observation period. During this period,   the boy displayed a considerable improvement of asthma control   and an increase in quality of life. In addition, his previously   poor lung function normalized.


  Plasmapheresis prior to omalizumab administration is suitable to   temporarily reduce grossly elevated serum IgE levels and might   facilitate anti-IgE therapy in selected patients previously   considered not suitable for this therapy.

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