Is there a role for omalizumab in a patient who is on VIT but still experiences anaphylaxis to stinging insects?

The Practice Parameters suggest that the dose should be doubled in such patients for improved protection, so omalizumab may not be the first step. Also, the frequency of the maintenance dose could be increased (e.g. every 2-3 weeks).

Although there may be a role for omalizumab (off-label) to reduce the risk of anaphylaxis, there are concerns about why the patient has not responded to VIT. How long has the patient been on an uninterrupted maintenance dose, and to which venoms? Describe the anaphylactic reaction to a sting pre-VIT, and while on VIT. Some relevant questions include: is there objective evidence of anaphylaxis?; what is the baseline serum tryptase level?; have there been reactions to VIT injections?; and why does the patient hav...