Background: Chronic Spontaneous urticarial (CSU) is a common dermatological problem characterized by recurrent pruritic or burning wheals last less than 24 hours and treated by many modalities of therapy including systemic antihistamines and in refractory cases with Omalizumab anti-IgE antibody biological injection. Latent tuberculosis infection (LTBI) is diagnosed based on a positive tuberculin skin test or QuantiFERON-TB test without evidence of active tuberculosis. Aim: To document a new case report of a patient with a history of CSU and latent tuberculosis on Omalizumab therapy during Isoniazid (INH) prophylaxis. Case Report: A-53-year-old woman with a history of CSU and newly identified LTBI who have been treated with INH monotherapy before starting Omalizumab injection followed up over 24 weeks course of therapy for any sign of tuberculosis reinfection. Conclusion: Omalizumab injection was used effectively for the treatment of CSU in a patient with latent tuberculosis infection with minimal risk of tuberculosis reactivation.
References
[1]
Agache, I., Rocha, C., Pereira, A., Song, Y., Alonso-Coello, P., Solà, I., et al. (2021) Efficacy and Safety of Treatment with Omalizumab for Chronic Spontaneous Urticaria: A Systematic Review for the EAACI Biologicals Guidelines. Allergy, 76, 59-70. https://doi.org/10.1111/all.14547
[2]
Zuberbier, T., Aberer, W., Asero, R., Abdul Latiff, A.H., Baker, D., Ballmer-Weber, B., et al. (2018) The EAACI/GA2LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis, and Management of Urticaria. Allergy, 73, 1393-1414. https://doi.org/10.1111/all.13397
[3]
Yuan, W., Hu, S., Li, M., Yang, L., Liu, L., Zheng, M., Guo, Z., Song, Z., Zhang, C., Diao, Q., Xu, J., Richard, A., Patwardhan, M., Lyu, T., Uddin, A., Fogel, R., Ligueros-Saylan, M. and Zheng, J. (2022) Efficacy and Safety of Omalizumab in Chinese Patients with Anti-Histamine Refractory Chronic Spontaneous Urticaria. Dermatologic Therapy, 35, e15303. https://doi.org/10.1111/dth.15303
[4]
Zhao, Z.T., Ji, C.M., Yu, W.J., Meng, L., Hawro, T., Wei, J.F., et al. (2016) Omalizumab for the Treatment of Chronic Spontaneous Urticaria: A Meta-Analysis of Randomized Clinical Trials. The Journal of Allergy and Clinical Immunology, 137, 1742-1750. https://doi.org/10.1016/j.jaci.2015.12.1342
[5]
World Health Organization (2011) Global Tuberculosis Control. https://www.who.int/publications-detail-redirect/9789241564380
[6]
World Health Organization (2022) Tuberculosis. https://www.who.int/news-room/fact-sheets/detail/tuberculosis
[7]
Wallis, R.S., Pai, M., Menzies, D., et al. (2010) Biomarkers and Diagnostics for Tuberculosis: Progress, Needs, and Translation into Practice. The Lancet, 375, 1920-1937. https://doi.org/10.1016/S0140-6736(10)60359-5
[8]
World Health Organization Regional Office for South-East Asia. Communicable Diseases Department, Tuberculosis, TB/HIV. http://www.searo.who.int/en/section10/section2097/section2129.htm
[9]
Doherty, S.D., van Voorhees, A., Lebwohl, M.G., et al. (2008) National Psoriasis Foundation Consensus Statement on Screening for Latent Tuberculosis Infection in Patients with Psoriasis Treated with Systemic and Biologic Agents. Journal of the American Academy of Dermatology, 59, 209-217. https://doi.org/10.1016/j.jaad.2008.03.023
[10]
Tubach, F., Salmon, D., Ravaud, P., Allanore, Y., Goupille, P., Bréban, M., et al. (2009) Risk of Tuberculosis Is Higher with Anti-Tumor Necrosis Factor Monoclonal Antibody Therapy than with Soluble Tumor Necrosis Factor Receptor Therapy: The Three-Year Prospective French Research Axed on Tolerance of Biotherapies Registry. Arthritis and Rheumatism, 60, 1884-1894. https://doi.org/10.1002/art.24632
University Hospitals Bristol NHS Foundation Trust (2018) Screening for Latent TB Infection Prior to Commencing Biological Therapy. https://www.gloshospitals.nhs.uk/media/documents/TB_screening_for_Biologic_and_Immunomodulatory_drugs.pdf
[13]
Clinical Guideline: TB Screening for Targeted and Biologic Agents: Prescribing including Anti-Tumour Necrosis Factor Drugs, Imperial College Healthcare NHS Trust, September 2020.
[14]
Abdulwahhab, W., Mehair, A. and Iedi, A. (2022) Ustekinumab Treatment in Patients with Moderate-to-Severe Psoriasis and Latent Tuberculosis Infection: A Study of 3 Case Reports. Journal of Cosmetics, Dermatological Sciences, and Applications, 12, 95-99. https://doi.org/10.4236/jcdsa.2022.122008
[15]
Saraceno, R. and Chimenti, S. (2008) How to Manage Infections in the Era of Biologics? Dermatologic Therapy, 21, 180-186. https://doi.org/10.1111/j.1529-8019.2008.00189.x
[16]
Goletti, D., Petrone, L., Ippolito, G., Niccoli, L., Nannini, C. and Cantini, F. (2018) Preventive Therapy for Tuberculosis in Rheumatological Patients Undergoing Therapy with Biological Drugs. Expert Review of Anti-Infective Therapy, 16, 501-512. https://doi.org/10.1080/14787210.2018.1483238
[17]
Cantini, F., Nannini, C., Niccoli, L., Iannone, F., Delogu, G., Garlaschi, G., Sanduzzi, A., Matucci, A., Prignano, F., Conversano, M. and Goletti, D., On Behalf of SAFEBIO (Italian multidisciplinary Task Force for Screening of Tuberculosis before and during Biologic Therapy) (2015) Guidance for the Management of Patients with Latent Tuberculosis Infection Requiring Biologic Therapy in Rheumatology and Dermatology Clinical Practice. Autoimmunity Reviews, 14, 503-509. https://doi.org/10.1016/j.autrev.2015.01.011
