Failure of omalizumab and successful control with ketotifen in a patient with vibratory angio-oedema

Vibratory angio-oedema is a rare form of physical urticaria characterized by pruriginous weals and angio-oedema at the site of exposure to vibration. Severe treatment-resistant disease can occur, and is associated with significant disability. Therapy with omalizumab, a monoclonal IgG anti-IgE antibody, has been shown to be successful in several types of physical urticaria. We report a patient with vibratory angio-oedema for whom all standard treatments for urticaria, including omalizumab, failed to show a clinical benefit. Finally, ketotifen was tried, and unexpectedly reduced symptoms significantly. Ketotifen may thus represent a therapeutic option in patients with treatment-resistant vibratory angio-oedema.