A 67-year-old white female with a 3-year history of recurrent, twice-weekly angioedemas of the lips, tongue and larynx. The clinical response of the angioedemas to the intake of antihistamines (AH) of doses up to three times higher than that normally recommended was not sufficient. Thus, glococorticosteroids (GCS) on a weekly basis were often necessary to control the symptoms. Omalizumab 150 mg was administered subcutaneously in 4-week intervals. After the first injection of omalizumab, facial swellings improved markedly. Treatment with AH and GCS were discontinued after 8 weeks. Omalizumab was paused after the fourth injection. Eleven weeks after stopping therapy, facial angioedemas reoccurred (Fig. ). Omalizumab 150 mg was resumed and the angioedema disappeared after 1 week. The patient stayed symptom-free. The interval between injections was stretched to every 2 months and the patient stayed symptom-free with only intermittent discrete eyelid swellings.
A 46-year-old white male suffering for 9 years from weekly recurrent non-itchy angioedemas on the feet, face and tongue. Due to laryngeal angioedema with airway-occlusion, emergency treatment was necessary in 2013. Suggested triggers were mechanical stress, cold, infections, and NSAIDs. Following a job change with associated mental pressure, angioedemas were not controllable with high doses of AH. Treatment with omalizumab was started, using 300 mg s.c. at monthly intervals. Concomitant AH intake was reduced and finally completely discontinued after 2 weeks. After 1 year of treatment, the dose was reduced to 150 mg and has been given every month since, without recurrence of symptoms.