Omalizumab facilitates oral desensitization after levothyroxine-induced anaphylactic shock: A case report
10.3760/cma.j.cn311282-20240620-00271
- VernacularTitle:奥马珠单抗辅助口服脱敏成功治疗左甲状腺素钠致过敏性休克病例报道一例
- Author:
Ruizhi JIAJUE
1
;
Miao YU
;
Le CUI
;
Lianglu WANG
;
Rui TANG
;
Lin LU
;
Kai FENG
;
Yuxiu LI
Author Information
1. 中国医学科学院，北京协和医院内分泌科 100730
- Keywords:
Thyrotropin suppression therapy;
Levothyroxine-induced anaphylactic shock;
Oral levothyroxine desensitization;
Omalizumab
- From:
Chinese Journal of Endocrinology and Metabolism
2024;40(10):879-883
- CountryChina
- Language:Chinese
-
Abstract:
Levothyroxine anaphylaxis is a rare yet severe adverse reaction to exogenous levothyroxine. While levothyroxine desensitization is commonly employed, its direct application in patients with severe shock poses considerable risks. Omalizumab may offer a potential adjunctive approach to induce tolerance to levothyroxine. We reported a case of a 30-year-old female with a history of thyroid papillary carcinoma who developed anaphylactic shock following oral administration of 50 μg levothyroxine daily after surgery. High serum level of immunoglobulin E (IgE 99.2 kU/L) and positive intradermal tests to all brands of levothyroxine available in China confirm a type Ⅰ hypersensitivity reaction. Several reports have proven the role of omalizumab in desensitization protocol in IgE-mediated diseases; therefore, she was pretreated with three courses of omalizumab (150 mg intradermal injection every four weeks). She then successfully completed oral levothyroxine desensitization and tolerated treatment dose of levothyroxine without experiencing allergic symptoms along with normalization of thyroid function. Further research is warranted to assess its potential as a standard treatment in difficult-to-treat levothyroxine hypersensitivity.
