Short-term omalizumab as rescue therapy for alopecia areata flares during JAK inhibitor maintenance

This retrospectively analyzed 9 patients with alopecia areata who experienced acute flares during JAK inhibitor maintenance without tapering. All patients had an atopic background, and 7 of 9 (77.8%) had elevated serum immunoglobulin E (IgE). Median baseline SALT was 90. After an initial response to JAK inhibitors (median SALT 3), patients relapsed (W0 median SALT 20). SALT did not change significantly at W4, but improved by W12 (median 9; p<0.05 vs W0) and remained stable through W24.AA has traditionally been viewed as Th1-dominant, but evidence supports a Th2/allergic component, especially in patients with allergic comorbidities. Elevated IgE has been linked to greater disease severity and poorer treatment response.
In our cohort, on-treatment flares occurred mainly in patients with atopy and high IgE. Omalizumab may help by neutralizing IgE and dampening mast-cell/eosinophil activation. The delayed, sustained improvement from week 12 suggests gradual immunomodulation.Clinically, these findings suggest that short-term omalizumab may be a rescue option for AA flares during JAK inhibitor therapy, especially in patients with atopic predisposition and elevated IgE.