851 - Systemic Pain Relief after Omalizumab Injection in Patient with Hypermobile Ehlers Danlos Syndrome: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

NC

Neyha Cherin, DO

Associate Professor, Consult Director
Penn State Health Department of Physical Medicine and Rehabilitation, Penn State College of Medicine
Hummelstown, Pennsylvania, United States

Co-Author(s)

SJ

Sarahrose Jonik, BS

Medical Student
Penn State College of Medicine
Hershey, Pennsylvania, United States

Co-Author(s)

AR

Andrew J. Rothka, BS

Medical Student
Penn State College of Medicine
Clarks Summit, Pennsylvania, United States

Case Diagnosis: Omalizumab injections providing systemic pain relief in a patient with hypermobile Ehlers-Danlos Syndrome

Case Description: We present a case of a 33-year-old female who follows with Physical Medicine and Rehabilitation for ongoing treatment of hypermobile Ehlers-Danlos Syndrome (hEDS) and comorbid conditions with the goal of improved strength, mobility, and quality of life who had significantly decreased pain after receiving omalizumab injections.

Discussions: The patient began receiving omalizumab injections for her mast cell activation syndrome. After receiving 5 injections, the patient reported a significant improvement in her inflammation, with notably reduced swelling, increased mobility, and decreased pain. While still limited by fatigue, she notes an overall reduction in her systemic symptoms, leading to a reduction in oral diphenhydramine from 6-8 diphenhydramine daily to only a few pills per week.

Ultimately, the reduction in this patient’s systemic inflammatory symptoms and chronic pain after initiating omalizumab therapy prompted the authors to research possible links between antihistamines, omalizumab, and chronic pain relief. Pain is a hallmark of inflammation, and there is evidence suggesting mast cells play a role in the pain signaling by secreting mediators that induce peripheral sensitization. Targeting mast cell activation and production may improve analgesic therapy for systemic pain.

Conclusions: Our patient with hEDS and mast cell activation syndrome showed significant improvement in her chronic pain after Omalizumab. Though omalizumab can be used to treat comorbidities of EDS, we propose there may be some use in considering this medication as a first-line therapy in patients with hEDS and other connective tissue disorders. Further research can evaluate the relationship between omalizumab and pain in EDS more closely. With the potential for omalizumab to reduce pain in EDS, patients could integrate this therapy into their regiment sooner, with the hope to improve overall patient outcomes in terms of functionality, social interaction, mobility, pain, and quality of life.