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

Omalizumab facilitates oral desensitization after levothyroxine-induced anaphylactic shock:A case report

左甲状腺素钠超敏反应是使用外源性左甲状腺素钠的罕见但严重的不良反应。左甲状腺素钠脱敏疗法是最广泛使用的治疗方法。然而,对于严重过敏性休克的患者,直接进行脱敏治疗风险很大,使用奥马珠单抗可能有助于诱导患者对左甲状腺素钠建立耐受。本文报道了1例甲状腺乳头状癌术后的30岁女性,口服左甲状腺素钠50μg qd后出现了过敏性休克。结合患者血清免疫球蛋白E(IgE)水平升高(99.2 kU/L),左甲状腺素钠皮内试验阳性,证实该患者出现了Ⅰ型超敏反应。部分报道证实了奥马珠单抗在IgE介导疾病的脱敏方案中的作用。因此,本文患者在接受了3个疗程的奥马珠单抗预处理后(每4周皮内注射150 mg),成功完成了左甲状腺素钠的口服脱敏治疗,并能耐受治疗剂量的左甲状腺素钠,且无过敏症状,甲状腺功能也恢复正常。对于难治性左甲状腺素钠过敏病例,是否应考虑将奥马珠单抗作为标准治疗方法,还有待进一步研究。

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 50μg 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 typeⅠhypersensitivity 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.