USE OF OMALIZUMAB IN FOUR-YEAR-OLD WITH SEVERE PERSISTENT ALLERGIC ASTHMA

Introduction Omalizumab is approved in patients with moderate to severe persistent allergic asthma older than 6 years of age. We report use of omalizumab for the treatment of uncontrolled asthma in a 4-year-old. Case Description Patient is a 4-year-old boy who presented with uncontrolled, severe, persistent asthma despite use of high dose inhaled corticosteroid and long acting beta agonist therapy. In addition to requiring systemic steroids as an outpatient, he had hospitalizations for an asthma exacerbation every month. His IgE was 636 U/ML and eosinophil count was 350/cmm. He was too young to appropriately perform a pulmonary function test. His allergen specific IgE testing showed multiple environmental allergen sensitivities. After starting the treatment with omalizumab, frequency of exacerbations requiring systemic steroids significantly decreased and he has not required hospitalization. Discussion Omalizumab, a monoclonal antibody against IgE, is approved for moderate to severe allergic asthma in children six years and older. There is difficulty in managing children who meet criteria for omalizumab treatment but due to age limit they are unable to qualify for this treatment. To our knowledge, there is limited evidence in the literature for omalizumab treatment in children less than six years of age. After starting omalizumab, the patient has significant improvement in quality of life and required less frequent use of systemic steroids. Omalizumab should be considered in certain circumstances in children younger than 6 years of age for severe persistent asthma unresponsive to conventional treatment to improve quality of life and for its steroid sparing effects.