{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:36Z","timestamp":1790982996191,"version":"4.1.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Bullous erythema multiforme (BEM) is an acute immune-mediated mucocutaneous disease, with drug induction being one of its common causes. Omalizumab, a recombinant humanized IgG1 monoclonal antibody targeting free IgE, is widely used in chronic spontaneous urticaria and asthma due to its favorable safety profile, while severe cutaneous bullous adverse reactions induced by it are extremely rare. We report a 36-year-old female patient with a history of bronchial asthma, allergic rhinitis, allergic conjunctivitis, and chronic spontaneous urticaria who developed generalized wheals. After the first subcutaneous injection of omalizumab 300\u202fmg, multiple raised, edematous erythematous papules and plaques, vesicles, and bullae appeared on the trunk, limbs, palms, soles, and oral mucosa 17\u202fdays later, accompanied by fever, chills, and fatigue. Laboratory examinations showed elevated eosinophil count and IgE level, and skin biopsy from the left upper limb revealed focal epidermal necrotic keratinocytes, intraepidermal and subepidermal blister formation, and massive eosinophilic infiltration. The patient was diagnosed with omalizumab-induced BEM. Initial treatment with methylprednisolone combined with intravenous immunoglobulin (IVIG) was ineffective. The condition was successfully controlled after increasing the dose of methylprednisolone and adding oral upadacitinib. This case suggests that omalizumab may induce BEM, and combination therapy with high-dose glucocorticoids and JAK inhibitors may be an effective strategy for refractory cases. Clinicians should be alert to such rare adverse reactions when using omalizumab.<\/jats:p>","DOI":"10.3389\/fmed.2026.1881122","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:22:45Z","timestamp":1784262165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Bullous erythema multiforme induced by omalizumab"],"prefix":"10.3389","volume":"13","author":[{"given":"Zenan","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Peking University People's Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Peking University People's Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1111\/j.1365-4632.2011.05348.x","article-title":"Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist","volume":"51","author":"Sokumbi","year":"2012","journal-title":"Int J Dermatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/s0190-9622(83)80003-6","article-title":"Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes","volume":"8","author":"Huff","year":"1983","journal-title":"J Am Acad Dermatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/j.jaci.2004.11.053","article-title":"The anti-inflammatory effects of omalizumab confirm the central role of IgE in allergic inflammation","volume":"115","author":"Holgate","year":"2005","journal-title":"J Allergy Clin Immunol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1435370","DOI":"10.3389\/fmed.2024.1435370","article-title":"A comprehensive analysis on the safety of two biologics dupilumab and omalizumab","volume":"11","author":"Xiao","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1080\/14712598.2017.1285903","article-title":"Omalizumab for treating chronic spontaneous urticaria: an expert review on efficacy and safety","volume":"17","author":"Gim\u00e9nez-Arnau","year":"2017","journal-title":"Expert Opin Biol Ther"},{"key":"ref6","first-page":"82","article-title":"Erythema multiforme: recognition and management","volume":"100","author":"Trayes","year":"2019","journal-title":"Am Fam Physician"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.anai.2018.06.014","article-title":"Omalizumab in chronic spontaneous urticaria: efficacy, safety, predictors of treatment outcome, and time to response","volume":"121","author":"Nettis","year":"2018","journal-title":"Ann Allergy Asthma Immunol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1111\/all.13539","article-title":"Omalizumab-induced erythema multiforme in a patient with chronic spontaneous urticaria","volume":"73","author":"Sipahi","year":"2018","journal-title":"Allergy"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/ddg.14118","article-title":"Erythema multiforme, Stevens-Johnson syndrome\/toxic epidermal necrolysis - diagnosis and treatment","volume":"18","author":"Gr\u00fcnwald","year":"2020","journal-title":"J Dtsch Dermatol Ges"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1007\/s12325-017-0530-y","article-title":"Stevens-Johnson syndrome and toxic epidermal necrolysis: a concise review with a comprehensive summary of therapeutic interventions emphasizing supportive measures","volume":"34","author":"Schneider","year":"2017","journal-title":"Adv Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s41927-018-0031-x","article-title":"In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494)","volume":"2","author":"Parmentier","year":"2018","journal-title":"BMC Rheumatol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1001\/jamadermatol.2021.4084","article-title":"Treatment of persistent erythema Multiforme with Janus kinase inhibition and the role of interferon gamma and interleukin 15 in its pathogenesis","volume":"157","author":"Murphy","year":"2021","journal-title":"JAMA Dermatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jdcr.2023.02.010","article-title":"Treatment of persistent erythema multiforme with upadacitinib: a novel therapeutic approach","volume":"34","author":"Deutsch","year":"2023","journal-title":"JAAD Case Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.1111\/1346-8138.16938","article-title":"A case of persistent erythema multiforme treated with upadacitinib","volume":"51","author":"Lee","year":"2024","journal-title":"J Dermatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1881122\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:22:48Z","timestamp":1784262168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1881122\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":14,"alternative-id":["10.3389\/fmed.2026.1881122"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1881122","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"article-number":"1881122"}}