Dramatic improvement of bullous pemphigoid with omalizumab in an elderly patient

Abstract

A 70-year-old man with a history of hypertension was evaluated in our dermatology department due to the appearance of a clinical picture compatible with bullous pemphigoid that was confirmed histologically. The lack of response to topical and systemic immunosuppressive treatment resulted in omalizumab being prescribed in a multidisciplinary committee based on the clinical and analytical findings and the patient's refusal to be treated with rituximab. The evaluation at 3 months showed the absence of blisters on the clinical examination. No associated adverse effects were observed. In the following 3 months the patient was administered medication at home in the absence of an anaphylactic reaction and with prior training by the nursing staff of the Hospital Pharmacy Service. After 6 months the medication was suspended with no relapses for 6 months since the last dose. Omalizumab, an anti-IgE monoclonal drug which has a good safety profile with minimum adverse side effects should be considered when there is a contraindication to the use of intravenous therapies (eg, immunoglobulins, rituximab) or prolonged immunosuppressive treatment (eg, methotrexate, azathioprine).