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Use of Omalizumab to treat a nine-year old, with steroid-dependent, allergic asthma, adrenal insufficiency and vertebral compression fractures due to steroid induced severe osteoporosis

  • Alicia Ring
  • Caroline Rizk
  • Stephanie Santucci
  • Joanne Desormeaux
  • Ian MacLuskey
  • Jacob Karsh
  • William H Yang
Open Access
Meeting abstract
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Keywords

Asthma Bone Density Skin Prick Testing Adrenal Insufficiency Compression Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

In Canada, Omalizumab is indicated for adults and adolescents with moderate to severe persistent allergic asthma, but not for pediatric use (<12 years of age). A 9 year-old boy with steroid dependent, allergic asthma, multiple ICU admissions and severe back pain from compression fractures was referred to our centre. IgE was 1337 IU/ml. Skin prick testing showed multiple positive reactions. Asthma treatment included inhaled corticosteroids and frequent courses of oral prednisone.

Methods

After obtaining necessary approvals and informed consents, Omalizumab treatment, 375mg every 2 weeks, was initiated in September 2010. Serum cortisol levels, bone density, spirometry, and PAQLQ were used to monitor clinical response.

Results

After 11 months, the changes below were noted.

Table 1

 

Daily Prednisone

Daily ICS dose

FEV1

Serum cortisol

Bone density*

PAQLQ

2010a

30 mg

800 mcg

1.46 L

12 nmol/L

0.626 g/cm2

4.7

2011 b

NIL

200 mcg

1.98 L

215 nmol/L

0.686 g/cm2

7

a Pre Omalizumab treatment

b Post Omalizumab treatment

Morning results, range 185 – 624 nmol/L

*Total hip

Pediatric asthma quality of life questionnaire with standardized activities: low 1 – 7 high

Conclusions

The patient improved and was off oral/inhaled corticosteroids with no asthma exacerbations. Spirometry, serum cortisol, PAQLQ and bone density improved. Prednisone treatment in young asthmatic children can be associated with serious side effects. Omalizumab therapy can permit steroid withdrawal and resolution of side effects.

Copyright information

© Ring et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • Alicia Ring
    • 1
  • Caroline Rizk
    • 2
  • Stephanie Santucci
    • 1
  • Joanne Desormeaux
    • 1
  • Ian MacLuskey
    • 2
  • Jacob Karsh
    • 2
  • William H Yang
    • 1
    • 2
  1. 1.Allergy and Asthma Research CentreOttawaCanada
  2. 2.University of Ottawa Medical SchoolOttawaCanada

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