Therapy of allergic bronchial asthma with omalizumab - an anti-IgE monoclonal antibody

The immunoglobulin E (IgE) antibody plays a central role in the allergic immune responses, such as those which characterise allergic bronchial asthma. The ability to reduce circulating IgE by using anti-IgE antibodies represents a novel therapeutic approach for IgE-mediated allergic diseases. Omalizumab (rhuMAb-E25/Xolair Genentech, USA/Tanox, Inc., USA/Novartis Pharma AG, Switzerland) is a non-anaphylactogen humanised murine monoclonal antibody which binds to circulating IgE. Therapeutic use of an anti-IgE antibody in the treatment of asthma was first suggested in preliminary studies in which omalizumab demonstrated efficacy in attenuating both the early- and late-phase bronchial responses to inhaled allergens in atopic subjects. Treatment with omalizumab has demonstrated both a significant beneficial effect on a number of measures, and a favourable safety profile. It reduces the frequency of asthma exacerbations and the need for inhaled corticosteroids (ICSs), and improves asthma symptoms, lung function and quality of life. The anti-IgE approach to asthma treatment has a number of further potential advantages, such as the treatment of other concomitant atopic diseases (allergic conjunctivitis and rhinitis, atopic dermatitis and food allergy), regardless of the type of allergic sensitisation (seasonal or perennial). On the basis of several studies, omalizumab is likely to provide a new strategy for treating atopic asthma.     

过敏性哮喘患者抗IgE治疗智慧提醒系统的设计及应用

目的 设计、 开发过敏性哮喘患者抗IgE治疗智慧提醒系统并评价其应用效果.方法 基于专家共识、药品说明书和临床实践经验,设计开发具有注射提醒、预约提醒、适应证错误提醒和健康教育内容提醒功能的抗IgE治疗智慧提醒系统.便利选取2019年5月—10月在湖北省某三级甲等医院门诊接受抗IgE治疗的22例过敏性哮喘患者作为试验组...     

The role of anti-IgE in managing difficult-to-treat or severe asthma

Until recently, treatment options for those with severe or difficult-to-treat asthma have been restricted to the use of beta 2-agonists and corticosteroids. It has been increasingly recognised that such patients need a new approach. This article discusses how anti-immunoglobulin E treatment could contribute to the successful management of patients with this condition.     

Role of immunotherapy in the treatment of allergic asthma

Allergen-specific immunotherapy (SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient’s preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.     

Omalizumab,a novel anti-IgE therapy in allergic disorders

The incidence of allergic diseases is increasing to epidemic proportions both in the developed and developing world with increasing medical costs and lost productivity. The discovery of immunoglobulin (Ig) E heralded a new era in pathophysiological understanding of allergic disorders. Twenty-five years later, a humanised, non-anaphylactogenic antibody was developed against IgE that could provide a therapeutic alternative to the existing medications. RhuMAb-E25 (omalizumab, Xolair^®, Genetech, Inc.) is a novel anti-IgE antibody that is directed against the receptor-binding domain of IgE. This binding is specific towards free IgE thereby preventing it from attaching to the mast cell and its subsequent activation. Initial studies demonstrated attenuation of the early and late asthmatic responses when anti-IgE was administered to asthmatic subjects. Later this novel molecule was found to improve symptom scores, rescue medication use, quality of life scores and peak expiratory flows in patients with allergic asthma. Most importantly, omalizumab treatment reduced the corticosteroid use in asthmatic individuals. In patients with seasonal allergic rhinitis, there was a significant reduction in the nasal and ocular symptoms as well as the use of rescue medications. Omalizumab also demonstrated a high level of safety in adults, adolescents and children with a side effect profile no different from the placebo. Its development is an exciting milestone in the treatment of allergic diseases.     

The use of corticosteroids in the treatment of acute asthma.

A study of 23 patients admitted to hospital with severe acute asthma is reported in which plasma cortisol level on admission was significantly correlated with the degree of acidaemia and pulse rate. Patients who had not previously received treatment with corticosteroids responded satisfactorily to repeated daily injections of tetracosactrin depot, the rate of improvement being comparable to that observed in other patients treated with intravenous hydrocortisone hemisuccinate. A prompt and sustained rise in plasma cortisol was also seen following tetracosactrin. The total daily dose of hydrocortisone required to achieve plasma cortisol levels above 100 mug/100 ml was less when given by continuous intravenous infusion compared with intermittent injections, and a regime of 3 mg/kg body weight every six hours by infusion appeared satisfactory. Most patients reported subjective improvement by about four hours after starting treatment but objective evidence did not appear until about six hours from the start. Measurements of FEV1 and FVC proved to be the most reliable indices of the beginning of improvement although pulse rate was the first index to show maximum improvement. Previous maintenance treatment with corticosteroids in patients with asthma did not appear materially to affect the plasma half-life of intravenous hydrocortisone (4 mgm/kg body weight) when compared with healthy subjects or other patients with asthma who had not previously been treated with corticosteroids.     

Treatment of allergic diseases with monoclonal anti-IgE antibody]

IgE-mediated mast cell and basophil activation initiates immediate and late-phase allergic responses, and plays a pivotal role in the pathogenesis of allergic diseases such as bronchial asthma and allergic rhinitis. Thus, the blocking of the binding of IgE to the high affinity receptors for IgE (Fc epsilon RI) on mast cells and basophils may prevent dual responses, and improve allergic symptoms. A recombinant humanized monoclonal antibody (rhuMAb-E25) forms complexes with free IgE, blocks its binding to mast cells and basophils, and inhibits allergen-induced mediator release from both cells and attenuates immediate and late-phase reactions to inhaled allergens. In clinical trials, the therapy with rhuMAb-E25 was effective in patients with atopic asthma and allergic rhinitis and well tolerated. This antibody seems to be promising as a treatment for atopic asthma and allergic rhinitis.     

Targeting memory Th2 cells for the treatment of allergic asthma

Th2 memory cells play an important role in the pathogenesis of allergic asthma. Evidence from patients and experimental models indicates that memory Th2 cells reside in the lungs during disease remission and, upon allergen exposure, become activated effectors involved in disease exacerbation. The inhibition of memory Th2 cells or their effector functions in allergic asthma influence disease progression, suggesting their importance as therapeutic targets. They are allergen specific and can potentially be suppressed or eliminated using this specificity. They have distinct activation, differentiation, cell surface phenotype, migration capacity, and effector functions that can be targeted singularly or in combination. Furthermore, memory Th2 cells residing in the lungs can be treated locally. Capitalizing on these unique attributes is important for drug development for allergic asthma. The aim of this review is to present an overview of therapeutic strategies targeting Th2 memory cells in allergic asthma, emphasizing Th2 generation, differentiation, activation, migration, effector function, and survival.     

Managing asthma in the allergic patient

Asthma is a chronic disease afflicting more than 12 million people in the United States alone. In many patients, environmental allergens trigger their asthma. Physicians can control the disease with modification of the environment and education of the patient in allergen avoidance.     

护理干预对过敏性哮喘患者脱敏治疗的影响

目的探讨对过敏性哮喘患者进行脱敏治疗的护理指导方法及效果。方法将确诊的100例过敏性哮喘患者按照患者自愿选择的原则分为对照组37名和试验组63名。对照组患者给予常规护理指导;试验组患者,在常规护理指导基础上,通过专家讲座和电话随访进行教育指导。结果经过一年的治疗,试验组患者的遵医行为和疗效优于对照组（P〈0.01）。结论专家讲座和电话随访是常规护理指导的有益补充。     

孟鲁司特联合补肾温肺方治疗支气管哮喘合并变应性鼻炎的临床分析

[摘要]目的 观察孟鲁司特联合补肾温肺方对支气管哮喘合并变应性鼻炎的疗效，并探讨其发病机制。方法 将本科40例患者随机分为对照组和观察组，对照组服用孟鲁司特，观察组在此基础上加服中药方剂补肾温肺方。结果 观察组治疗后支气管哮喘和变应性鼻炎的有效率分别为90.0%、85.0%，明显优于对照组的60.0%和55.0%（P<0.05）；IgE、FEV、PEF、哮喘症状、鼻炎症状和生活质量等指标明显得到改善，且均优于对照组（P<0.05）。结论 支气管哮喘患者往往合并变应性鼻炎，应及早发现，采用孟鲁司特联合补肾温肺方进行综合治疗，可取得较好疗效。     

过敏性哮喘基因检测阳性患儿长期吸入布地奈德的临床探讨

目的探讨过敏性哮喘基因检测阳性患儿长期吸入布地奈德的疗效及安全性。方法选取过敏性哮喘基因检测阳性患儿106例,随机分为布地奈德A组(39例)和布地奈德B组(37例)及地塞米松组(30例)。布地奈德A、B组均给予吸入用布地奈德混悬液吸入,地塞米松组给予地塞米松磷酸钠注射液。达临床治愈后,布地奈德A组继续给予小剂量布地奈德雾化吸入治疗半年,其余2组不再给予治疗。结果在临床治愈期间,布地奈德A、B组患儿症状缓解及住院时间均短于地塞米松组(P0.05或P0.01)。随访期间,布地奈德A组患儿喘息发作次数低于布地奈德B组及地塞米松组(P0.05),布地奈德A组最大呼吸流量占预计值百分比(PEF%)和一秒钟用力呼气量占预计值百分比(FEV1%)优于布地奈德B组及地塞米松组(P0.01)。结论雾化吸入布地奈德临床疗效优于地塞米松静脉滴注,长程、规律、小剂量的应用布地奈德对患儿喘息症状的控制及肺功能的改善优于短期应用,且未见其对身高、体质量增长的抑制。     

Environmental controls in the management of allergic asthma

Environmental allergen control is one of the four primary goals of good asthma management. The American Academy of Allergy, Asthma, and Immunology has published a position statement [78] that endorses the National Asthma Education and Prevention Program management guidelines [23] and recommends that every patient with persistent asthma be evaluated for environmental allergen sensitivity. Patients who have sensitivities should receive practical advice on allergen avoidance. An accumulating body of knowledge indicates that such measures, when strictly applied for a sufficient period of time, can indeed reduce asthma symptoms, need for medication, and airway hyperresponsiveness. Ongoing prospective trials in large numbers of patients are being conducted and should enhance the ability to make proper recommendations to patients.