IgE blockade in autoimmunity: Omalizumab induced remission of bullous pemphigoid

Talia James, Sam Salman, Brittany Stevenson, Christine Bundell, Gavin Kelly, David Nolan, Mina John

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Bullous pemphigoid (BP) is a blistering dermopathy and a prototypic antibody-mediated autoimmune disease. Detection of IgG autoantibodies against hemidesmosomal proteins BP180 and/or BP230 are diagnostic and levels can correlate with disease activity. Therapies include corticosteroids and oral immunosuppressants, while intravenous immunoglobulin and rituximab are reserved for treatment resistant cases. Here we describe a patient with severe BP which was refractory to standard first line therapy, intravenous immunoglobulin and rituximab induced depletion of peripheral B cells. Use of the monoclonal anti-IgE antibody omalizumab resulted in rapid resolution of blistering despite ongoing high levels of anti-skin IgG antibodies. To our knowledge this is the first case of BP responsive to omalizumab after failure of rituximab to be reported. This case adds to emerging data on omalizumab as a novel BP treatment as well as providing new evidence of an independent role for autoreactive IgE-mediated inflammation in the formation of BP skin lesions.

Original languageEnglish
Pages (from-to)54-56
Number of pages3
JournalClinical Immunology
Volume198
DOIs
Publication statusPublished - Jan 2019

Cite this

James, Talia ; Salman, Sam ; Stevenson, Brittany ; Bundell, Christine ; Kelly, Gavin ; Nolan, David ; John, Mina. / IgE blockade in autoimmunity : Omalizumab induced remission of bullous pemphigoid. In: Clinical Immunology. 2019 ; Vol. 198. pp. 54-56.
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abstract = "Bullous pemphigoid (BP) is a blistering dermopathy and a prototypic antibody-mediated autoimmune disease. Detection of IgG autoantibodies against hemidesmosomal proteins BP180 and/or BP230 are diagnostic and levels can correlate with disease activity. Therapies include corticosteroids and oral immunosuppressants, while intravenous immunoglobulin and rituximab are reserved for treatment resistant cases. Here we describe a patient with severe BP which was refractory to standard first line therapy, intravenous immunoglobulin and rituximab induced depletion of peripheral B cells. Use of the monoclonal anti-IgE antibody omalizumab resulted in rapid resolution of blistering despite ongoing high levels of anti-skin IgG antibodies. To our knowledge this is the first case of BP responsive to omalizumab after failure of rituximab to be reported. This case adds to emerging data on omalizumab as a novel BP treatment as well as providing new evidence of an independent role for autoreactive IgE-mediated inflammation in the formation of BP skin lesions.",
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IgE blockade in autoimmunity : Omalizumab induced remission of bullous pemphigoid. / James, Talia; Salman, Sam; Stevenson, Brittany; Bundell, Christine; Kelly, Gavin; Nolan, David; John, Mina.

In: Clinical Immunology, Vol. 198, 01.2019, p. 54-56.

Research output: Contribution to journalArticle

TY - JOUR

T1 - IgE blockade in autoimmunity

T2 - Omalizumab induced remission of bullous pemphigoid

AU - James, Talia

AU - Salman, Sam

AU - Stevenson, Brittany

AU - Bundell, Christine

AU - Kelly, Gavin

AU - Nolan, David

AU - John, Mina

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AB - Bullous pemphigoid (BP) is a blistering dermopathy and a prototypic antibody-mediated autoimmune disease. Detection of IgG autoantibodies against hemidesmosomal proteins BP180 and/or BP230 are diagnostic and levels can correlate with disease activity. Therapies include corticosteroids and oral immunosuppressants, while intravenous immunoglobulin and rituximab are reserved for treatment resistant cases. Here we describe a patient with severe BP which was refractory to standard first line therapy, intravenous immunoglobulin and rituximab induced depletion of peripheral B cells. Use of the monoclonal anti-IgE antibody omalizumab resulted in rapid resolution of blistering despite ongoing high levels of anti-skin IgG antibodies. To our knowledge this is the first case of BP responsive to omalizumab after failure of rituximab to be reported. This case adds to emerging data on omalizumab as a novel BP treatment as well as providing new evidence of an independent role for autoreactive IgE-mediated inflammation in the formation of BP skin lesions.

KW - Bullous Pemphigoid

KW - Omalizumab

KW - Autoreactive IgE

KW - HUMAN SKIN

KW - AUTOANTIBODIES

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SN - 1521-6616

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