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Abstract: The patient, a 21-year-old male, presented with recurrent wind masses and erythema all over the body with pruritus, which was initially diagnosed as chronic urticaria, a common allergic disease. Since chronic urticaria seriously affects the patient’s life and work, after clear diagnosis, the patient was given injectable omalizumab, loratadine tablets and other medications, while paying attention to avoidance of allergens. After treatment, the patient’s condition was stable, no recurrence of wind masses and erythema, and rhinitis was improved.
Basic information】Male, 21 years old
Disease Type】Chronic urticaria
Hospital】Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
Time】April 2021
Treatment plan】Allergen avoidance + medication (omalizumab for injection, loratadine tablets, vitamin C tablets, glyburide lotion)
Treatment period】4 months of outpatient treatment
Effectiveness】Stable condition, no recurrence of wind and red spots, and improvement of rhinitis
I. Initial consultation
The patient came to the clinic because of skin bumps with itching. During the consultation, the patient kept scratching, frowning and full of anxiety. After the appendectomy one year ago, the patient started to have recurrent generalized wind, erythema and itching, which often worsened at night and often woke up with itching, without obvious lip and mouth edema and abdominal pain, dyspnea and other discomfort. Patients can’t help scratching, often scratching the skin, bleeding, etc., thus increasing the pain. The patient had a positive skin scratch test and a past history of allergic rhinitis for more than 5 years, and was treated with nasal hormones. The patient was given an allergen test showing house dust mite >100KUA/L, dust mite 94.71KUA/L and total lgE 352.0KU/L, thus confirming the diagnosis of chronic urticaria.
II. Treatment history
With clear allergens, the patient was advised to avoid contact with known allergens such as house dust mites and dust mites. At the same time, the patient was recommended recombinant humanized anti-lgE monoclonal antibody, such as omalizumab for injection, which is a relatively new biologic agent used in clinical practice for the treatment of chronic urticaria in recent years, and the patient decided to try it after consideration. The first phase was supplemented with a small amount of loratadine tablets, vitamin C tablets, and topical application of glyburide lotion, and the patient gradually reduced oral loratadine tablets after his condition improved.
III. Treatment effect
After 1 week of using omalizumab for injection, the patient’s chronic urticaria improved significantly, and loratadine tablets were reduced; after 4 months of treatment, the patient completely stopped loratadine tablets, and the condition was stable at this time, and no more wind clusters and erythema occurred. At the same time, the patient’s rhinitis symptoms also improved significantly, and no more nasal hormones and other drugs were used for treatment.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. Although chronic urticaria is considered to be a self-limiting disease, it generally has a long course, and its etiology is complex with many influencing factors. Therefore, patients are advised to avoid allergens, physical stimuli such as heat and cold, do not exercise strenuously, avoid tight clothes, choose softer and looser clothing, and pay attention to diet to avoid spicy and alcoholic drinks, etc. Patients generally need to take oral anti-allergy drugs for a long time, but the drug reactions of these drugs vary greatly among individuals, some of them are not effective, and some of them have serious drowsiness. Patients with drowsiness as a side effect should pay strict attention to avoid driving and working at height, and also pay attention to avoid drinking alcohol.
V. Personal insight
The prevalence of chronic urticaria has increased significantly in recent years, and there is a wide variation in the therapeutic response of patients to antihistamines. In this case, the patient’s drowsiness was obvious after the application of antihistamines. If the examination reveals that the patient’s total lgE is high, you can communicate with the patient and try to use recombinant humanized anti-lgE monoclonal antibody treatment. These patients generally respond well to recombinant humanized anti-lgE monoclonal antibody and their condition will be significantly improved. Also this drug has a good alleviating effect on allergic rhinitis and allergic asthma.