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Clin Exp Allergy. 2005 Apr;35(4):408-16.Related Articles, Links

Anti-immunoglobulin E treatment with omalizumab in allergic diseases: an

update on anti-inflammatory activity and clinical efficacy.

Holgate ST, Djukanovic R, Casale T, Bousquet J.

Southampton General Hospital, Southampton, UK.

Summary Omalizumab is a humanized monoclonal anti-IgE antibody developed for

the treatment of allergic disease, with established efficacy in patients with

moderate-to-severe allergic asthma and in patients with intermittent

(seasonal) and persistent (perennial) allergic rhinitis (AR). Omalizumab is

known to

result in a marked reduction in serum levels of free IgE and down-regulation of

IgE receptors on circulating basophils. Recent work has shed further light on

its mechanism of action, showing significant and profound reductions in tissue

(nasal and bronchial) eosinophils and in bronchial IgE(+) cells (mast cells),

as well as T cells and B cells. Omalizumab treatment was also shown to be

associated with down-regulation of IgE receptors on circulating (precursor)

dendritic cells, suggesting that blocking IgE may inhibit more chronic aspects

of

allergic inflammation involving T cell activation. Further work with omalizumab

demonstrated it to have important benefits in patients with poorly controlled

asthma despite high-dose inhaled corticosteroid therapy, and analysis of

clinical data suggests that the patients who are the best 'responders' to

anti-IgE

treatment are those with asthma at the more severe end of the spectrum.

Notably, systemic anti-IgE therapy with omalizumab has been shown to improve

symptoms, quality of life and disease control (asthma exacerbations) in patients

with concomitant asthma and persistent AR. These impressive clinical data and

the

studies elucidating the anti-inflammatory profile of omalizumab also serve to

emphasize the fundamental importance of IgE in the pathogenesis of allergic

diseases.