Anti-IgE monoclonal antibody (omalizumab) is effective in treating bullous pemphigoid and its effects on soluble CD200.

Herein, we report a case of a man with pruritic bullous pemphigoid (BP) and very high levels of total IgE (5000 kU/L) who was refractory to standard aggressive immunosuppressive regimens (systemic steroids, daily cyclophosphamide) for BP but responded rapidly to systemic anti-IgE (omalizumab). Our patient is a 28 year-old white male. On admission 70% of his body surface area was involved with large bullae overlying urticarial plaques, involving his upper and lower extremities, chest, and abdomen. The circulating level of sCD200 was 48.45 pg/mL in serum and 243 pg/mL in blister fluid. During the second month of follow-up, the patient's sCD200 level decreased to 26.7 pg/mL. After the second round of omalizumab (300 mg), frequency of exacerbations decreased and after the 13th round it had completely disappeared.