Posted on Authorea 28 Jun 2021 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.162487988.85048238/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. niIEmncoa nioy hsi h rtdmntaino h ffiayo mlzmbi uhunusual such in Background omalizumab of and efficacy Introduction the of with patient demonstration therapy a first label of off the case allergy. to is the life-threatening responded This describe completely we antibody. who Here bites, monoclonal mosquito manifestations. anti-IgE after clinical anaphylaxis severe relapsing to from raise suffering give rarely can improvement allergy and Mosquito is risk therapy of preventive reduction approved for patients. no Abstract option these date, therapeutic in To promising life of a life-threatening. quality be but of could rare, omalizumab is but available, bite mosquito after Anaphylaxis Message Clinical Key fi[email protected] 6932304 055 +39 Italy Florence, 50143 Dio di Giovanni San Ospedale Nuovo Clinica Immunologia e Allergologia SOC Fassio Filippo Dr. Author: *Corresponding Italy Florence, omalizumab Hospital, anaphylaxis, Dio allergy, di mosquito Giovanni Keywords: San Unit, D Immunology Macchia Clinical allergy MCL, and mosquito Iorno Allergy severe F*, Fassio with A, patient Radice a E, in Meucci episodes anaphylactic of prevention allergy. life-threatening for unusual Omalizumab such re- in from omalizumab suffering antibody.This patient of monoclonal a efficacy anti-IgE with of the therapy case of label the demonstration off describe to first responded we the completely manifestations.Here is who clinical bites, severe mosquito to after anaphylaxis raise lapsing give rarely can allergy Mosquito Abstract 2021 28, June Centro Toscana 1 Macchia Donatella Meucci Elisa patient allergy a mosquito in severe episodes with anaphylactic of prevention for Omalizumab leg n lnclImnlg nt seaeSnGoan iDo zed USL Azienda Dio, di Giovanni San Ospedale Unit, Immunology Clinical and Allergy 1 naRadice Anna , 1 1 asoFilippo Fassio , 1 ai oeaaCir Iorno Chiara Loredana Maria , 1 1 and , Posted on Authorea 28 Jun 2021 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.162487988.85048238/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. fe ealdmdclhsoy h ain eerdta ohratosto lc utatrreceiving after allergy mosquito just Therefore, place took reactions. reactions local both large that only provoked referred previously patient which the bites, history, mosquito ascer- medical several and detailed presyncope a summertime. urticaria, After in by outdoor characterized dinner episodes during anaphylactic hypotension, two of tained presence experienced systemic the he experiencing al). for recently, after et region crabro More Muller endemic Vespa to and (an dominula according Italy Tuscany, Polistes III in for (grade living VIT man, reactions begun 51-year-old already a had of who case mosquitoes) the patients. report these we Here in challenging worldwide, exceedingly date is to (QoL) report reported life been Case have of bites quality mosquito and to risk anaphylaxis and of of scientific cases management thirty a than available from commercially less not if both are Even allergy time, mosquito over for faded products VIT gradually today allergy that anymore. mosquitoes) so mosquito case, view, toward of approach this interest point the pharmaceutical (in hand, change vectors other deeply could of the vaccines saliva On such with of diseases. efficacy host infectious the the severe mosquito-borne pathogens; preventing against of of of transmission protect interaction the to The favor tested to been allergies. seems them. have than of proteins one rather salivary just mosquito disease in against achieved vaccines was mosquito interest, resolution Of on reac- complete mentioned, local of previously extracts: reduction as body was depend, mosquito endpoint could using primary their that that symptoms, allergens. noted respiratory body be even and to eventually has groups and it little tions but to promising, limited were results are Their (VIT) but immunotherapy venom increase extracts. mosquito could whole-body used regarding levels have studies specific-IgE existing mosquitoes’ hypersen- few cases, developing The IgG4. of these and risk in IgG1 the against specific desensitization: protective with natural be together a to seems to and has bites due bodies saliva mosquitoes’ sitivity, mosquitoes’ mosquitoes’ to from exposure and derived prolonged IgE, The allergens saliva-specific suspended of of inhalation presence after the emanations. source. individuals to allergen sensitized main in due the place is as allergy confirmed mosquito been cases, most In giving a venom, wasp’s Aed of and allergy. syndrome, that 2 bee wasp/mosquito with a reactive and so-called Aed cross the 1, as identified to a in been Aed rise has them, present hyaluronidase allergens among mosquito is salivary 7); the which 22 Moreover, a of (Aed mosquito), allergens tropomyosin total genuine fever a a potentially including yellow identified are allergens, world, (the 4 body the aegypti four throughout only Aedes regions and temperate on and primarily subtropical humans. conducted tropical, bites studies rarely (Aedes it date, mosquito but korean To present emerged also newly Tox- the is namely common and mosquitoes subfamilies, albopictus) detected: Anopheles three (Aedes been koreicus); have mosquito of species tiger consists mosquito pipiens), main which (Culex three Culicidae, Italy, mosquito In family Culicinae. Diptera, and order described. Anophelinae orhynchitinae, been the have immediate to episodes develop 1). anaphylactic belong usually circumstances (Table Mosquitoes exceptional individuals in sensitized bites but case, reactions, mosquito latter local this large by delayed In or triggered allergy. are mosquito including disorders uncommon, mediated immune Several 3 10,11 7 w ujcswodvlpdaahlxsatrmsut iewr ie oqioVIT mosquito given were bite mosquito after anaphylaxis developed who subjects Two . 10–13 5 9 ec,msut leg smr rqeti hlrnta nadults. in than children in frequent more is allergy mosquito Hence, 15 8 20 vnmr nomny yesniiiyratoscntake can reactions hypersensitivity uncommonly, more Even 6 n eetsuycreae oqio(ee communis) (Aedes mosquito correlates study recent a and 2 4 1,2 14 l fteeaequite are these of All 8,14,16–19 3 Posted on Authorea 28 Jun 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162487988.85048238/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. t ffiayi xlie ihteetbihdoaiua ehns fato fbnigfe g and IgE free binding mastcells. on of omalizumab action of effect of apoptotic mechanism an omalizumab postulated Authors established some the FcMoreover, therapies. of with standard treat- downregulation explained to the subsequent refractory is for urticaria Europe efficacy spontaneous in chronic Its approved and asthma antibody allergic anti-IgE severe monoclonal of humanized ment recombinant a is judged was Omalizumab antibody monoclonal choice. anti-IgE management pathophysiology, suitable of underlying most failure the the conditions. targeting a drugs allergic in other other result for in could risk Looking seen area, the as reducing endemic of mosquito QoL, capable in and options a living risk therapeutic for patients of other responsible at-risk or allergy, for is mosquito analphylaxis VIT for of of elevated, QoL. immunotherapy pathways is an in anaphylaxis of improvement pathogenic lack of significant The the risk a which target and in risk can allergy, of venom it allergens. reduction hymenoptera to strong since of tolerance treatment, case inducing the and modifying In history disease natural a its altering as response defined allergic disease. been period of the has burden was is psychological VIT patient of October the reduction to parallel, significant In (March a year date. reported to this Discussion and relapses March activities without Tuscany), in outdoor in again resume bites to started mosquito nor able for was risk episodes therapy at anaphylactic the more neither considered result, experiencing good without the Given bites mosquito 2020. several October reactions. received hypersensitivity to he mild August from period, weeks, monoclonal this anti-IgE 4 the In every with therapy subcutaneously off-label mg started patient 300 local the omalizumab, options, large antibody therapeutic other and of absence wheal the and In itching weak reducing is evidence in its ones. demonstrated since challenging. systemic preventing was been in choice not has its but antihistamines reactions impact but of considered, major was effectiveness a therapy The had prophylactic them, a avoiding for in need difficulty the Therefore, the sudden with of risk along QoL. potential patients’ bites, the the this normal however, mosquito (+1). to on autoinjectors; to within score epinephrine due reactions two resulted REMA indicated carry allergic the and always not severe to to evaluated was according advised was was biopsy disorder patient tryptase marrow cell The mast bone basal clonal but serum a performed disorder, of was probability cell low consultation and mast hematological tropomyosin a a as of range; such suspicion allergens the results. cross-reactive negative In gave potential which bites. against (CCD), mosquito derminants IgE to carbohydrate reactions included cross-reactive saliva, IV workup its Mueller allergologic of as interpreted instead The were body, whole episodes patient. anaphylactic insect our two the in the is positivity Therefore, kit weak ImmunoCAP the kU/l; mosquito 100 explain the < could of this n.v. source and kU/l, allergen communis 300 the Aedes IgE note, total against kUA/l, Of IgE 0.35 specific < Sweden). Italy, Uppsala, in n.v. available Scientific, kUA/l, longer ThermoFisher (0.53 ImmunoCAP, no increased resulted are and extract evaluated mosquito were with tests skin Since suspected. was 10,11 n,aya,i sn ogravailable. longer no is it anyway, and, Io atel,bspis oiohl n nie presenting-cells. antigen and eosinophils basophils, mastcells, on RI 22,23 nimnteaywt oqioetatwsntfeasible, not was extract mosquito with immunotherapy An 25 3 24 24 21 29–31 26,27 27,28 Posted on Authorea 28 Jun 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162487988.85048238/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. kee ydoeLrelclrato mr hn3c)ascae ihfvradsmtmslmhdnpty curn e or fe ye htrcvr n31 as ti utie yIGadIEaantmsut saliva. mosquito against IgE and IgG by sustained is It days. 3-10 in episodes recovers anaphylactic that life-threatening bytes systemic, after to hours reactions few local a large occurring or lymphadenopathy, reactions sometimes flare and and fever by wheal with induced mild associated cellulitis From response cm) Eosinophilic immune 3 the than of (more reaction aspects Immunological local Large L. disease. allergens. Puerta Fern´andez-Caldas virus mosquito E, JF, role. Epstein-Barr Cantillo dominant active a 3. play Chronic Picture lymphocytes JI. Clinical CD4+ Cohen T H, symptoms. doi:10.3389/fimmu.2017.01867 allergy. systemic Kimura with Mosquito associated 2. KS. reaction skin Johnson intense an HC, involve bites Crisp doi:10.1016/j.anai.2012.07.023 mosquito to reactions immunodeficiencies 1. acquired or disorders/primary lymphoproliferative cell-associated References T/natural-killer virus-associated Epstein-Barr with patients In disease allergy (CAEBV) IgE-mediated virus Ebstein-Barr active Chronic syndrome Wells syndrome Skeeter Condition Clinical critical and preparation 1. manuscript Table to contributed Authors the all management, clinical revision. of bite. charge mosquito in was after ME anaphylaxis relapsing in effective masto- be contributions a to Author al., in proved et bite and mosquito N used after Reiter was by reactions omalizumab allergic proposed which severe already preventing was in patient omalizumab cytosis of with episodes dosage anaphylaxis therapy a against a chose effect Although protective we a patient guaranteeing our in bite. effective in proved mosquito especially publications, which anaphylaxis, after weeks, of aforementioned prevention 4 the the every in on mg omalizumab 300 based of use However, the for dosage. protocol regarding established no is there date, observed To was protection cases. of is two achievement hypersensitivity tests effective in quick venom considered skin episodes a when relapsing positive studies, mitigate indicated nor these to not In venom used is Hymenoptera successfully VIT was against Since Omalizumab IgE demonstrable, reactions. specific not anaphylactic exhibit threatening not life the do despite disorders. in sometimes even mast-cell anaphylaxis, with subjects idiopathic patients These of in risk and the reaction reducing IgE-independent in of effect context favourable of a phase the showed omalizumab build-up in Moreover, the disorders. even cell omalizumab, during demonstrated with mast reactions premedicated been with severe if patients has experiencing relapse in allergens not Those did offending allergy. VIT towards Hymenoptera venom tolerability Hymenoptera the of placebo. faster increasing receiving context achieved those in was to capacity tolerance compared Its protocols, food desensitization of the peanut amounts after higher during early to emerged and change and before this omalizumab cases using most When in dose, challenge treatment. omalizumab threshold the receiving the of adults allergic in beginning peanut increase that 56-fold demonstrated studies a previous showed allergy, anaphylaxis food of of incidence context reducing the settings, of In real-life capable and resulted trials it clinical in indication, allergens this different for by off-label triggered is use omalizumab if Even nomnciia odtosrltdt oqios bite. mosquitoes’ to related conditions clinical Uncommon 41 n rhAlryImmunol Allergy Arch Int hl 5 geeyscn ekwsascae ihlwrdge fprotection. of degree lower with associated was week second every mg 150 while , 33 31,38 04154:7-8.doi:10.1159/000371349 2014;165(4):271-282. . n leg,Atm Immunol Asthma Allergy, Ann 4 16 oorkoldeti stefis eotdcs in case reported first the is this knowledge our to 42 32 n h oaeo 0 gmnhywas mg/monthly 300 of dosage the and n vdnei nraigi hsregard. this in increasing is evidence and 34 35–37 rn Immunol Front n hseetwscnre also confirmed was effect this and 32,39–44 2013;110(2):65-69. . 2017;8(DEC):1-6. . 39,40 42 Posted on Authorea 28 Jun 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162487988.85048238/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 1 oaon ,Lmad ,ZntiR. Stings. http://www.jiaci.org/issues/vol24issue5/1.pdf Zanotti Insect 2018. C, 1, to Lombardo November Reactions P, Bonadonna Allergic 21. Severe with reports]. Experiences case doi:10.1056/nejm195908202610803 Further 2 1959;261(8):374-377. mosquito: HL. a bite]. Mueller by 20. mosquito caused [Anaphylaxis a A. Sabbah from M, (Paris) Drouet [Anaphylaxis S, Hassoun P. Mart´ın 19. Cosmes JC, http://www.ncbi.nlm.nih.gov/pubmed/7907159 1994;102(4):157. Ortiz hypersensitivity. Garc´ıa bite Mosquito 18. al. et systemic mosqui- J, in allergy http://www.ncbi.nlm.nih.gov/pubmed/9885733 a Borja mosquito 26(5):251-254. G´omez E, by of PA, caused Galindo Anaphylaxis immunogenicity Report 17. Case and al. et trial. Safety S, 1 Altrichter al. M, mastocytosis. phase Reiter et N, double-blind, Reiter V., placebo-controlled, 16. I randomised, a Coutinho-Abreu doi:10.1016/S0140-6736(20)31048-5 vaccine: F, 2020;395(10242):1998-2007. peptide-based Oliveira saliva Immu- JE, anaphylaxis: to bite Manning Mosquito RJ. 15. Engler GB, extracts. Carpenter body JN, whole Hershey with KF, notherapy Salata DR, McCormack inflammatory 14. skin severe bites. mosquito with quinquefasciatus children Culex in and doi:10.1111/j.1365-4362.1990.tb03479.x immunotherapy Children. aegypti Intradermal in Aedes to A. Bites reactions Fassrainer Mosquito C, to Benaim-Pinto Reaction 13. Local Large of Treatment the J Extract Organ Allergenic in With Aegypti Immunotherapy of Aedes Efficacy of al. et Gonz´alez-D´ıaz A, MA, Arias-Cruz Manrique S, 12. quinquefas- (Culex mosquito with study. Immunotherapy doi:10.1016/S1081-1206(10)60664-3 placebo-controlled SN. double-blind, Gaur a N, extract: Arora VT, ciatus) Sudha BP, Singh bites. D, Srivastava mosquito 11. to immunotherapy specific of ige safety human and Immunol Efficacy in Clin RC. Panzani increase R, Seasonal Ariano bites. 10. T. mosquito Reunala aedes T, to Sahi mosquito antibodies J, doi:10.1159/000237696 to antisaliva Mikkola responses lgg4 H, 2021. Immune Brummer-Korvenkontio and bites. FER. K, mosquito Simons Palosuo to NL, 4, 9. reactions Ott allergic DR, systemic acute Hoffman June doi:10.1016/j.jaci.2004.08.014 with RJ, 2004;114(5):1189-1194. individuals Engler 14 AN, in Accessed Beckett saliva Z, Hypersensi- Venom Peng Bee with 8. Study. Associated Italia? vivo Is Reactivity in communis and Aedes vitro al. in et An in CG, tivity: Uasuf L, Pirrotta syndrome]. E, wasp/mosquito Scala [The 7. esistono M. Doucet MG, Lauret M, zanzare Drouet (Paris) S, Hassoun A, Sabbah and di 6. Identification Fern´andez-Caldas E. L, Caraballo tipi JL, doi:10.1159/000447298 aegypti. Aedes Subiza 56. in S, Tropomyosins IgE-Binding Lafosse-Marin of L, quali Characterization Puerta JF, Cantillo 5. e Quanti https://www.greenme.it/vivere/salute-e-benessere/tipi-zanzare-esistenti-italia/ 4. 993()2527 http://www.ncbi.nlm.nih.gov/pubmed/10572584 1999;31(8):285-287. . http://www.ncbi.nlm.nih.gov/pubmed/10443298 1999;31(6):175-184. . 025S4.doi:10.1097/01.WOX.0000411578.60734.e0 2012;5:S147. . Lancet 043()1118 http://www.ncbi.nlm.nih.gov/pubmed/15180354 2004;36(4):131-138. . 033290)18.doi:10.1016/S0140-6736(13)61605-0 2013;382(9901):1380. . n rhAlryImmunol Allergy Arch Int n Allergy Ann atctssadAlri Diseases Allergic and Mastocytosis 1995;74(1):39-44. . 5 n leg shaImmunol Asthma Allergy Ann n rhAlryImmunol Allergy Arch Int 08162:0-0.doi:10.1159/000488866 2018;176(2):101-105. . n rhAlryImmunol Allergy Arch Int n Dermatol J Int leglImnpto (Madr) Immunopathol Allergol leg lnImmunol Clin Allergy J o 4;21.Accessed 2014. 24.; Vol . 1997;114(4):367-372. . 1990;29(8):600-601. . 2007;99(3):273-280. . e ln(Barc) Clin Med nlJMed J Engl N 2016;170(1):46- . u n Allergy Ann Eur legImmunol Allerg legImmunol Allerg ol Allergy World Lancet . . . . . Posted on Authorea 28 Jun 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162487988.85048238/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. fe I-nue npyai naptetwt ytmcmastocytosis. systemic with patient immunotherapy. a venom in bee anaphylaxis to VIT-induced tolerance after inducing venom G for bee tool 38. to useful anaphylaxis A Severe Omalizumab: P. Pharmacol Immunopathol L. Demoly Ricciardi C, omalizumab. Gallen 37. with S, treatment Caimmi concurrent N, and Immunol Zankar pretreatment Clin N, of efficacy Soohun specific C, immunotherapy: and Galera omalizumab of 36. combination a sting. with wasp doi:10.1177/039463201402700114 Treatment a 112. after M. anaphylaxis Gotz-Zbikowska severe peanut for Z, for immunotherapy desensitization Bartuzi oral K, rapid Pa cell, facilitates lgan 35. Omalizumab mast al. of et H, Kinetics Gragg RA. R, allergy. stu- Rachid Wood AJ, placebo-controlled SS, MacGinnitie allergy. 34. peanut Saini double-blind, with DW, adults omalizumab-treated Macglashan randomized in PM, responses challenge A Immunol Sterba food JP, oral al. and Courneya basophil, anaphylaxis. et JH, Savage idiopathic EH, 33. Brittain for I, omalizumab doi:10.1016/j.jaci.2020.11.005 Maric of MC, dy Carter immu-32. venom bee honey syndrome. ultrarush activation during cell anaphylaxis doi:10.1016/j.jaip.2013.07.004 mast mitigates monoclonal Omalizumab in KL. notherapy Randall lead EN, that Silva cells mast Da in 31. pathways signaling survival. stimulates cell IgE Monomeric and al. production et cytokine V, to Lam factor. M, Steel Huber by J, Kalesnikoff used pathways 30. those via from fibronectin to distinct adhesion but cell antigen mast + doi:10.1182/blood-2002-10-3176 stimulates IgE alone 1413. by IgE used al. those et to CWK, omalizu- similar Lee J, of Kalesnikoff efficacy V, Lam to 29. contribute develop- that urticaria. action and spontaneous Sponta- of chronic or Mechanisms in discovery Idiopathic SS. mab Chronic Saini Gim´enez-Arnau of The AM, AP, Treatment Kaplan the G. 28. for Omalizumab Ciprandi al. of et impact A, H-J, Urticaria. asthma. Hsieh neous The Ros´en Marseglia K, of luck”: M, Maurer treatment bad R, 27. just the Castagnoli it’s for G, illness, omalizumab doi:10.1517/17460441.2015.1048220 an Marseglia not of A, “It’s ment al. Licari et adults. 26. R, in life Hymenoptera Baretto of immunotherapy: AP, quality allergen on Huissoon on anaphylaxis RC, guidelines EAACI Knibb al. 25. et G, Roberts EM, allergy. venom Varga GJ, Sturm of treatment 24. the in mg 10 Rupatadine I. 3083.2012.04543.x Izquierdo allergy. T, mosquito-bite Reunala immediate H, Brummer-Korvenkontio A, Karppinen 23. reactions. bite Levocetirizine mosquito T. delayed Reunala Herv´e and JP, doi:10.2340/00015555-0085 H, immediate Kautiainen of L, treatment Petman for H, Brummer-Korvenkontio A, Karppinen 22. le ,R¨ffF ap .Oaiua nue optblt obevnmimnteay(VIT) immunotherapy venom bee to compatibility ensures Omalizumab U. Jappe Ru¨eff F, A, ulsen ¨ leg lnImmunol Clin Allergy J 02105.doi:10.1016/j.jaci.2012.05.039 2012;130(5). . 091()2529 http://www.ncbi.nlm.nih.gov/pubmed/19610266 2009;19(3):225-229. . leg u leg lnImmunol Clin Allergy J Eur Allergy nlJMed J Engl N 062()7678 doi:10.1177/0394632016670920 2016;29(4):726-728. . 03381)9495 doi:10.1056/NEJMoa1215372 2013;368(10):924-935. . u cdDraooyVenereol Dermatology Acad Eur J 07193:7-8.8 doi:10.1016/j.jaci.2016.08.010 2017;139(3):873-881.e8. . Allergy lnEpAllergy Exp Clin Immunity 077()5953 doi:10.1111/all.13083 2017;72(4):519-533. . leg lnImmunol Clin Allergy J 011()8181 doi:10.1016/S1074-7613(01)00159-5 2001;14(6):801-811. . 087()7474 doi:10.1111/all.13262 2018;73(4):744-764. . 6 xetOi rgDiscov Drug Opin Expert 094()14-06 doi:10.1111/cea.13410 2019;49(7):1040-1046. . leg lnImnlPract Immunol Clin Allergy J n muoahlPharmacol Immunopathol J Int caDr Venereol Derm Acta 022()9992 doi:10.1111/j.1468- 2012;26(7):919-922. . leglSel Allergol 2021;147(3):1004-1010.e2. . Blood 2015;10(9):1033-1042. . 2021;5(01):128-132. . 2006;86(4):329-331. . 2013;1(6):687-688. . 2003;102(4):1405- . netgAllergol Investig J 2014;27(1):109- . leg Clin Allergy J n J Int Posted on Authorea 28 Jun 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162487988.85048238/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 4 i` B atn ,TniiC oae E rsn T doahcanaphylaxis. Idiopathic MT. Krishna OE, Mohamed doi:10.1111/cea.13402 C, 2019;49(7):942-952. Tontini M, Martini Bil`o MB, Treat-44. A. omalizumab. Gonzalez-Estrada I, with in Carrillo-Martin anaphylaxis Symptoms doi:10.1016/j.anai.2019.09.020 G, idiopathic Cell-Mediator Motoa of JC, Mast ment Garcia-Saucedo for MC, Therapy Sanchez-Valenzuela MCAS. Omalizumab 43. and al. MMAS, et L, CM, doi:10.1016/j.jaip.2019.03.039 Terriou ISM, G, improves with Fouquet and Patients R, anaphylaxis prevents Lemal Omalizumab 42. al. the observations. et for safety and CG, doi:10.1111/all.13237 Omalizumab Efficacy 2018;73(1):230-238. Mortz mastocytosis: DD. systemic H, Metcalfe in Vestergaard symptoms GG, S, mastocytosis. Broesby-Olsen Shapiro systemic 41. JC, with Walker patients PB, in doi:10.1016/j.jaci.2007.03.032 Bressler anaphylaxis 2007;119(6):1550-1551. unprovoked JA, of Robyn treatment MC, un- and Carter sting IgE. 40. bee specific undetectable for and monotherapy mastocytosis Omalizumab systemic Immunol PG. with Panayiotidis Asthma patient C, a Voulgari in “anaphylaxis” CI, provoked Filis K, Kontou-Fili 39. doi:10.5414/alx02196e 00146:3-3.doi:10.1016/j.anai.2010.04.011 2010;104(6):537-539. . leg lnImnlPract Immunol Clin Allergy J n leg,Atm Immunol Asthma Allergy, Ann 7 leg u leg lnImmunol Clin Allergy J Eur Allergy leg lnImmunol Clin Allergy J 2019;7(7):2387-2395.e3. . 2019;123(6):612-613. . lnEpAllergy Exp Clin n Allergy, Ann . . .