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P31: Severe systemic allergic reactions to Jack Jumper Ant Venom Immunotherapy: basophil response during treatment with Omalizumab

Citation

Lau, WY and Mulcahy, EM and Wanandy, T and Tran, V, P31: Severe systemic allergic reactions to Jack Jumper Ant Venom Immunotherapy: basophil response during treatment with Omalizumab, 29th Annual Conference of the Australasian Society of Clinical Immunology and Allergy (ASCIA), 4-8 September, Canberra, pp. 13-13. ISSN 1444-0903 (2018) [Conference Extract]


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DOI: doi:10.1111/imj.31_14077

Abstract

Background

Recurrent severe systemic reactions to Jack Jumper Ant (JJA) Venom Immunotherapy (VIT) although rare, hinder a patient's ability to achieve protective maintenance doses. Patients who discontinue treatment remain at high risk of potentially life threatening reactions. The administration of concurrent Omalizumab has been reported to reduce the rate of such reactions. We sought to evaluate the basophil response during treatment with Omalizumab in this setting.

Case History

We describe the case of a 50 year old female who has suffered multiple episodes of severe anaphylaxis following JJA stings. She commenced JJA VIT by conventional semirush protocol complicated by a severe (Brown grade III) anaphylaxis following a 10 mcg JJA venom (JJAV) dose. She suffered a further moderate (Brown grade II) severity anaphylaxis three weeks later. Geographic considerations were significant and treatment proceeded with a modified ultrarush protocol. A cumulative total of 45mcg of JJAV was achieved before she experienced another severe (Brown grade III) anaphylaxis. A subsequent basophil activation test (BAT) demonstrated 44.4%, reactive, CD63 positive basophils at a dilution of 0.1 mcg/ml JJAV.

Immunotherapy was recommenced with the addition of Omalizumab 150 mcg 30 minutes before JJA VIT every fortnight. She achieved a maintenance dose of 50mcg JJAV 10 weeks later. A BAT was repeated 4 weeks following her first maintenance dose demonstrating no JJA venom basophil reactivity. Omalizumab was continued for 6 months. Three months after discontinuing Omalizumab our patient experienced a mild (Brown grade I) systemic reaction. Repeat BAT demonstrated reduction of CD63 positive, reactive, basophils from 44.4% to 18.9% at a dilution of 0.1mcg/ml JJAV.

Conclusion

Recurrent systemic VIT allergic reactions may occur after Omalizumab has been discontinued or reduced. The potential role of BAT for therapeutic monitoring in this setting is promising and requires further investigation.

Item Details

Item Type:Conference Extract
Keywords:allergy, allergic, jack jumper, ant venom
Research Division:Biomedical and Clinical Sciences
Research Group:Immunology
Research Field:Allergy
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Lau, WY (Miss Wun Lau)
UTAS Author:Mulcahy, EM (Dr Emily Mulcahy)
UTAS Author:Wanandy, T (Mr Troy Wanandy)
UTAS Author:Tran, V (Dr Viet Tran)
ID Code:142111
Year Published:2018
Deposited By:Medicine
Deposited On:2020-12-14
Last Modified:2021-05-21
Downloads:0

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