The authors present two cases of severe atopic dermatitis with extremely elevated IgE levels treated with omalizumab. The effect of this treatment was completely unconvincing in both patients, most likely because of extremely elevated IgE values, which could not be eliminated by omalizumab. Our observation is consistent with earlier published literature reporting that omalizumab as a treatment for atopic dermatitis seems to work better in patients with lower levels of IgE antibodies.