Anaphylaxis and omalizumab
Question:
6/18/2018
I saw a 63 year-old woman with moderate to severe persistent allergic asthma who developed about 20 hours after her 40th Xolair injection numbness and tingling of the face that spread to the upper chest followed by cough and wheezing and no other symptom or sign. She was given one nebulization with duoneb and the wheezing and cough subsided promptly but the paresthesias which were associated with fatigue resolved after 6 hours. She suffers from diabetes and hypertension both of which are controlled on medications. She had never experienced a similar event before. A CT scan of the head and neuro exam were unremarkable. Is there any significant risk from continuing Xolair such as the possibility of an anaphylactic reaction?
Answer:
It would be atypical to see a patient have an IgE mediated reaction 20 hours after the injection of omalizumab. The reported symptom of numbness and tingling of the face also seems unusual for an IgE mediated reaction and to me would suggest a hyperventilation syndrome with paresthesia. I have seen patients who hyperventilate and develop shortness of breath and "wheezing" which was probably from paradoxical movement of the vocal cords. Click here for a summary by Dr. Leiberman on omalizumab and anaphylaxis that should be helpful for you.
I hope this has been helpful.
Andrew Murphy MD FAAAAI