The use of anti-IgE in the treatment of allergic asthma

Allergic sensitization plays a significant role in the development of asthma in many patients. IgE-mediated immune responses play a central role in the pathogenesis of this condition. The development of a treatment that interrupts this pathway is particularly desirable to prevent downstream events. Large-scale trials in patients ranging in age from 6 to 76 years have shown that omalizumab therapy is safe and effective in the treatment of severe allergic asthma. This is particularly true in patients who experience poor disease control despite high doses of inhaled steroids or need oral steroids for control of their disease. These patients are at risk for severe exacerbations despite recommended therapy, and anti-IgE therapy has proved to reduce these episodes. Early aggressive therapy of asthma is needed for maximum control in all age groups. Despite the efficacy of inhaled steroids there is a reluctance to use these agents, especially in younger children. Because of these concerns a long-acting treatment is especially desirable. Because of imperfect effort or technique limiting inhaled medications, introduction of an effective agent that could be administered parenterally at long intervals also is very important. Allergic rhinitis is a co-existing problem in many patients with allergic asthma. Immunotherapy trials have suggested that early intervention with immunotherapy and allergic rhinitis patients may actually prevent the development of asthma. Early treatment of patients with anti-IgE may also have benefits, particularly in those who have concomitant allergic rhinitis in addition to allergic asthma. Although omalizumab has not yet received Food and Drug Administration approval in the United States, it shows great promise in the management of patients requiring high doses of inhaled or oral corticosteroids for control of their disease and to prevent exacerbations of asthma in such patients. Reductions in high doses of inhaled or oral corticosteroids may prevent long-term complications of these treatments.