Xolair 'add-on' helpful in uncontrolled dermatitis

Individuals with severe persistent dermatitis who fail to gain adequate control despite standard treatments may find relief with the addition of Xolair (omalizumab), according to a group of dermatologists from Georgia.

Xolair is a laboratory-generated monoclonal antibody that is given by injection. It is designed to bind to IgE, a naturally occurring antibody, and prevent it from triggering the release of chemicals that provoke asthma and allergy attacks.

Xolair is approved for the treatment of asthma in patients 12 years of age or older who have IgE levels up to 700 IU/mL.

Dr. Joshua E. Lane, of Dermatologic Surgery Specialists of Macon, and colleagues tried Xolair in three patients aged 10 to 13 with severe refractory dermatitis and IgE levels ranging from 1990 to 6120 IU/mL.

"Our patients are unique as their IgE levels far exceeded the typical range previously considered acceptable for treatment with (Xolair)," they note in the Journal of the American Academy of Dermatology.

All three patients failed to improve with conventional therapies including topical and oral steroids, repeated courses of oral antibiotics, antihistamines, as well as other more potent agents.

However, injections of Xolair, in combination with some of these other therapies, produced significant improvements in all three patients, the clinicians report.

Severe recalcitrant dermatitis "often presents a therapeutic challenge," Lane said. There is no perfect single therapy for this disease, "and therapy often requires a finely tuned mix of medications individualized to each patient."

The use of Xolair "represents an additional treatment tool" for patients with hard-to-handle dermatitis, Lane said.

SOURCE: Journal of the American Academy of Dermatology, January 2006.