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Bee Safe: Omalizumab to the Rescue for Anaphylactic Beekeeper on Venom Immunotherapy
Lorie-Mae Nicolas, MD1, GisooGhaffari, MD1
1 Section of Allergy, Asthma and Immunology, Penn State College of Medicine, Hershey, Pennsylvania
Introduction
Anaphylaxis to Hymenoptera venom is a life-threatening hypersensitivity reaction, affecting 14-47% of beekeepers. While life-long bee venom immunotherapy (b-VIT) is effective in preventing anaphylaxis, it may also be a risk for anaphylaxis. We report a case of a beekeeper with honeybee allergy undergoing b-VIT, who experienced recurrent anaphylaxis requiring epinephrine for whom omalizumab was introduced and mitigated systemic reactions. This patient is the first case in our clinic who receives Omalizumab in conjunction with b-VIT, due to anaphylaxis
Case Description
32-year-old woman, beekeeper, presented with worsening reactions consistent with anaphylaxis to honeybee stings, had positive testing only to honeybee. While on built-up on b-VIT, developed anaphylactic reactions, requiring epinephrine administration. De-escalating the immunotherapy dose, did not prevent anaphylactic episodes. Omalizumab was started to achieve the effective dose of b-VIT.
Summary
Honeybee stings cause high rates of recurrent anaphylactic reactions. A life-long b-VIT is life-saving in patients with history of anaphylaxis and sensitization to honeybees. Omalizumab, a humanized monoclonal antibody, has been shown to be successfully used in conjunction with b-VIT in patients who experienced systemic reactions to b-VIT. After initiation of Omalizumab, patient was able to achieve maintenance b-VIT without anaphylactic reaction. Patient was sting by honeybee since reaching maintenance, with only localized reaction.