Abstract
IgE is an immunoglobulin that plays a central role in acute allergic reactions and chronic inflammatory allergic diseases. The development of a drug able to neutralize this antibody represents a breakthrough in the treatment of inflammatory pathologies with a probable allergic basis. This review focuses on IgE-related chronic diseases, such as allergic asthma and chronic urticaria (CU), and on the role of the anti-IgE monoclonal antibody, omalizumab, in their treatment. We also assess the off-label use of omalizumab for other pathologies associated with IgE and report the latest findings concerning this drug and other new related drugs. To date, omalizumab has only been approved for severe allergic asthma and unresponsive chronic urticaria treatments. In allergic asthma, omalizumab has demonstrated its efficacy in reducing the dose of inhaled corticosteroids required by patients, decreasing the number of asthma exacerbations, and limiting the effect on airway remodeling. In CU, omalizumab treatment rapidly improves symptoms and in some cases achieves complete disease remission. In systemic mastocytosis, omalizumab also improves symptoms and its prophylactic use to prevent anaphylactic reactions has also been discussed. In other pathologies such as atopic dermatitis, food allergy, allergic rhinitis, nasal polyposis, and keratoconjunctivitis, omalizumab significantly improves clinical manifestations. Omalizumab acts in two ways: by sequestering free IgE and by accelerating the dissociation of the IgE-Fcε receptor I complex.
Highlights
IgE has unique properties among immunoglobulin isotypes and plays a central role in the pathophysiology of acute allergic reactions and chronic inflammatory allergic diseases
This review focuses on IgE-related chronic diseases, such as allergic asthma and chronic urticaria (CU), and on the role of the anti-IgE monoclonal antibody, omalizumab, in their treatment
IgE binding to FcεRI increases cell survival and receptor upregulation [2, 3] and upon contact with a specific allergen induces the release of pharmacologically active mediators stored in the granules of mast cells (MC) and blood basophils (BS), resulting in clinical manifestations of type 1 hypersensitivity
Summary
IgE has unique properties among immunoglobulin isotypes and plays a central role in the pathophysiology of acute allergic reactions and chronic inflammatory allergic diseases. IgE binding to FcεRI increases cell survival and receptor upregulation [2, 3] and upon contact with a specific allergen induces the release of pharmacologically active mediators stored in the granules of mast cells (MC) and blood basophils (BS), resulting in clinical manifestations of type 1 hypersensitivity. Later exposure to the same allergen cross-links the bound IgE on sensitized cells, resulting in degranulation and secretion of preformed pharmacologically active mediators such as histamine. All of this occurs as an immediate reaction, starting within seconds. Some reports have noted the drug’s beneficial role in conditions, which apparently are not IgE-mediated [8] If this efficacy is demonstrated, the uses of this biological drug may be extended to the treatment of other diseases. They will be discussed in this review, but it is by no means clear whether they will eventually be used in humans
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