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Distler M, Maul JT, Steiner UC, Jandus P, Kolios AGA, Murer C, Graf N, Seebach JD, Pichler WJ, Navarini AA, French LE, Helbling A, Schmid-Grendelmeier P. Efficacy of Omalizumab in Mastocytosis: Allusive Indication Obtained from a Prospective, Double-Blind, Multicenter Study (XOLMA Study). Dermatology 2020; 236:529-539. [PMID: 31958790 DOI: 10.1159/000504842] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with mastocytosis often suffer from a variety of symptoms caused by mast cell mediators where treatments remain difficult, showing various success rates. Omalizumab, a monoclonal anti-IgE antibody, has been postulated to have a positive impact on mastocytosis-associated symptoms such as flush, vertigo, gastrointestinal problems, or anaphylaxis. OBJECTIVE To investigate the efficacy and safety of omalizumab in systemic mastocytosis. METHODS Patients with histologically proven mastocytosis were investigated in a multicenter prospective double-blind placebo-controlled trial to receive either omalizumab or placebo, dosed according to IgE and body weight. The primary endpoint was change in the AFIRMM activity score after 6 months of treatment. Different laboratory parameters were analyzed. RESULTS Sixteen patients were analyzed: 7 to omalizumab and 9 to placebo (mean age 47.7 ± 13.8 vs. 45.4 ± 8.8 years; 66.6 vs. 85.7% were female; mean disease duration 10.0 ± 5.1 vs. 4.5 ± 2.9 years, respectively). After 6 months the median AFIRMM score decreased 50% from 52.0 to 26.0 in the omalizumab group versus 104.0-102.0 in the placebo group (p = 0.286); however, the difference was not significant (p = 0.941). Secondary endpoints, including the number of allergic reactions, changes in major complaints, wheal-and-flare reaction due to mechanical irritation (Darier's sign), and frequency of the use of mastocytosis-specific drugs improved in the omalizumab group, but not significantly. Adverse events like urticaria, bronchospasm, and anaphylactic shock showed no significant difference between the groups. No severe adverse events occurred. FcεRI (Fc-epsilon receptor) expression on basophils decreased after receiving omalizumab versus placebo. CONCLUSION Omalizumab was safe and showed a tendency to improve mastocytosis-related symptoms, in particular diarrhea, dizziness, flush, and anaphylactic reactions, including the AFIRMM score and secondary endpoints; however, the difference was not significant. Due to the small study size and difference at baseline between the study groups, further studies are required to confirm our findings.
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Affiliation(s)
- Meike Distler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Urs C Steiner
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland
| | - Antonios G A Kolios
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Carla Murer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jörg D Seebach
- Division of Immunology and Allergology, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland
| | - Werner J Pichler
- Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland.,ADR-AC GmbH Berne, Zurich, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Lars E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Arthur Helbling
- Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland
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Escande H, Bennani I, Bulai Livideanu C, Uthurriague C, Paul C, Nougué J. [IgE mediated anaphylaxis in a patient with systemic mastocytosis]. Ann Dermatol Venereol 2013; 140:641-4. [PMID: 24090896 DOI: 10.1016/j.annder.2012.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/19/2012] [Accepted: 06/28/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anaphylaxis is a severe, generalized, life-threatening reaction of rapid onset. We report the case of a patient presenting several systemic anaphylactic reactions over many years, initially ascribed to a cereals allergy but which finally proved to be due to systemic mastocytosis hidden for a long time. PATIENTS AND METHODS A 53-year-old man consulted for an eruption consisting of monomorphic pigmented maculopapular lesions on the trunk associated with itching and urticaria. He was a farmer and presented severe sensitivity to cereals, with anaphylaxis, which continued despite withdrawal of these allergens. Skin and bone marrow infiltration, abnormal mast cells, positivity for c-kit 816 mutation and the persistent elevation of serum tryptase enabled a diagnosis of indolent systemic mastocytosis to be made. DISCUSSION In systemic mastocytosis anaphylaxis is an expected complication relating to the proliferation of mast cells and a massive increase in mediator release (non-immunological mechanism). All patients with severe and recurrent anaphylaxis should be analyzed for underlying mastocytosis by careful physical examination and assay of baseline tryptase.
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Affiliation(s)
- H Escande
- Service de dermatologie, centre hospitalier de Montauban, 100, rue Léon-Cladel, BP 765, 82013 Montauban cedex, France; Service de dermatologie, hôpital Larrey, université Paul-Sabatier, CHU, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
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Abstract
The prominent role for mast cells in the inflammatory response has been increasingly well documented in recent years. Mast cells not only contribute to maintain homeostasis via degranulation and to generate IgE-mediated allergic reactions, but also sit at a major crossroads for both innate and adaptive immune responses. The part played by mast cells in chronic inflammatory diseases such as rheumatoid arthritis and multiple sclerosis identifies mast cells as a valuable treatment target in these diseases. Tyrosine-kinase inhibitors targeting the c-Kit mast cell receptor have been found effective in treating rheumatoid arthritis, asthma, and multiple sclerosis. When used in combination with other available drugs, tyrosine-kinase inhibitors may improve the therapeutic management of these diseases.
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Affiliation(s)
- Laurent Frenzel
- Service d'Hématologie Adulte, Centre de référence des mastocytoses, CNRS UMR 8147, Institut Imagine, Hôpital Necker-Enfants-Malades, 75015 Paris, France.
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