Case Study: Omalizumab-Induced Bullous Erythema Multiforme
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By
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Zenan Tang
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Yan Zhao
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July 17, 2026
Clinical Scorecard: Case Study: Omalizumab-Induced Bullous Erythema Multiforme
At a Glance
| Category | Detail |
|---|
| Condition | Bullous Erythema Multiforme (BEM) |
| Key Mechanisms | Immune-mediated mucocutaneous disease triggered by drug exposure, specifically omalizumab. |
| Target Population | Patients with chronic spontaneous urticaria and other allergic conditions. |
| Care Setting | Clinical case study in a hospital setting. |
Key Highlights
- Omalizumab can induce bullous erythema multiforme, a rare adverse reaction.
- The patient developed symptoms 17 days post-omalizumab injection.
- Initial treatment with methylprednisolone and IVIG was ineffective.
- Successful management involved increasing methylprednisolone and adding oral upadacitinib.
- Clinicians should be vigilant for rare adverse reactions when prescribing omalizumab.
Guideline-Based Recommendations
Diagnosis
- Diagnosis based on clinical history, laboratory findings, and skin biopsy.
Management
- Combination therapy with high-dose glucocorticoids and JAK inhibitors for refractory cases.
Monitoring & Follow-up
- Monitor for signs of adverse reactions following omalizumab administration.
Risks
- Risk of severe cutaneous adverse reactions, including bullous erythema multiforme.
Patient & Prescribing Data
Adult patients with chronic spontaneous urticaria.
Omalizumab is generally safe but can lead to rare immune-mediated reactions.
Clinical Best Practices
- Conduct thorough assessments of recent drug exposures in patients presenting with bullous lesions.
- Consider alternative treatment strategies for patients with refractory conditions.
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