CRA39 LOW DOSE OMALIZUMAB IN PREGNANCY WITH SEVERE ASTHMA - DOES IT WORK? A CASE REPORT

Noor Esafirah Binti Zakaria, Farrah Suraya Binti Kamarudin, Chan Tha A Hing, Arvindran Alaga
Respiratory Department, Hospital Sultanah Bahiyah Alor Setar Kedah

Introduction

Severe asthma is defined as uncontrolled asthma symptoms despite adherence to maximally optimised therapy. Severe asthma can be categorised into severe allergic asthma and eosinophilic asthma. The safety of using biologics in pregnancy is less explored.

Case report

We report a case of a 27-year-old Malay lady with G2P3 at 12 weeks of gestation with a known case of severe allergic asthma and allergic rhinitis. She had frequent exacerbations during her pregnancy, despite on triple therapy and good adherence. She required a total of five hospital admissions, including twice admission to the ICU. Her serum IgE is 270, and her eosinophil count ranges from 230 to 270. Subsequently, a low dose of Omalizumab (150 mg) was administered twice weekly at 26 weeks of gestation with no complications observed. Since then, the asthma symptoms have been well controlled. The obstetrics monitoring and foetal growth show no foetal abnormality. She subsequently delivered a healthy baby at 37 weeks of gestation.

Discussion

Omalizumab is a recombination-humanised monoclonal antibody that specifically targets circulating IgE. Poorly controlled asthma in pregnancy can be associated with obstetric complications. In the EXPECT trial, there was no evidence of an increased risk of major congenital anomalies following exposure to Omalizumab among pregnant women. While in Malaysia, there is no published case report yet to show the evidence of the safety of Omalizumab use in pregnancy.

Conclusion

Based on our case study, the use of low-dose Omalizumab in pregnancy with severe allergic asthma is favorable. This will prevent further exacerbations, which can be associated with obstetrical complications.