Successful Omalizumab Treatment of Rhinogenic Contact Point Headache Complicated by Severe Cedar Pollinosis: A Case...

Headache is one of the most common neurological disorders in children. The most common headache in children is a primary headache, including migraine and tension-type headache, but note that secondary headaches should be differentiated as a cause of headache in pediatric patients. The management of cedar pollinosis in pediatric patients is important because it can cause quality-of-life deficits in addition to nasal and ocular symptoms. Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, is approved in Japan as an add-on treatment option for severe cedar pollinosis, but few studies have investigated its real-world clinical efficacy in pediatric patients with seasonal allergic rhinitis. We report the case of a 15-year-old male patient with cedar pollinosis who suffered from uncontrolled naso-ocular symptoms, facial pain, and headache despite using histamine H₁-receptor antagonists and intranasal corticosteroid spray. A sinus computed tomography scan and nasal endoscopic findings showed a swollen inferior turbinate and nasal septum in contact with the nasal cavity ipsilateral to the headache. Application of local anesthesia to the contact points within the nasal cavity resulted in the rapid relief of headaches. Therefore, we diagnosed rhinogenic contact point headache triggered by cedar pollinosis and initiated the add-on therapy of omalizumab for seasonal allergic rhinitis. Three days after the administration of omalizumab, his naso-ocular symptoms, quality-of-life deficits, and headache improved markedly, accompanied by improved nasal endoscopic findings. Omalizumab was immediately effective for the treatment of rhinogenic contact point headaches complicated by severe cedar pollinosis in a pediatric patient.