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The present study should enable the clinician to recognize when treatment of MCAD with omalizumab is contraindicated because of the potential risk of severe serum sickness and to report our successful therapeutic strategy for such adverse event (AE). Our clinical observations, a review of the literature including the event reports in the FDA AE Reporting System, the European Medicines Agency Eudra-Vigilance databases (preferred search terms: omalizumab, Xolair\u00ae, and serum sickness) and information from the manufacturer\u2019s Novartis database were used. Omalizumab therapy may be more likely to cause serum sickness than previously thought. In patients with regular adrenal function, serum sickness can occur after 3 to 10\u00a0days which resolves after the antigen and circulating immune complexes are cleared. If the symptoms do not resolve within a week, injection of 20 to 40\u00a0mg of prednisolone on two consecutive days could be given. However, in MCAD patients whose adrenal cortical function is completely suppressed by exogenous glucocorticoid therapy, there is a high risk that serum sickness will be masked by the MCAD and evolve in a severe form with pronounced damage of organs and tissues, potentially leading to death. Therefore, before the application of the first omalizumab dose, it is important to ensure that the function of the adrenal cortex is not significantly limited so that any occurring type III allergy can be self-limiting.<\/jats:p>","DOI":"10.1007\/s00210-020-01886-2","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T18:03:41Z","timestamp":1588788221000},"page":"1573-1580","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Adrenal insufficiency is a contraindication for omalizumab therapy in mast cell activation disease: risk for serum sickness"],"prefix":"10.1007","volume":"393","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9005-2749","authenticated-orcid":false,"given":"G. J.","family":"Molderings","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. 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Molderings is chief medical officer of the company MC Sciences developing drugs for therapy of mast cell diseases. All other authors have stated that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Publication was supported by the F\u00f6rderclub Mastzellforschung e.V. Informed consents for publication have been obtained from our patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}