Abstract
Omalizumab, a human immunoglobulin (Ig)G1 antibody against IgE, is a therapeutic agent for bronchial asthma. The Global Initiative for Asthma guidelines indicate that the use of omalizumab should be considered as an option in step 5 of treatment for patients with the most severe type of bronchial asthma. In patients with atopic asthma who are at a high risk of exacerbation, and in whom symptoms are poorly controlled despite treatment with inhaled corticosteroids, omalizumab is one of the few drugs that improves symptoms, reduces the risk of exacerbation, and improves the quality of life while offering a high level of safety. On the other hand, the associated treatment costs are high, and there are no clear methods to identify responders. A recent study suggested that evaluating the therapeutic effects and monitoring the pharmacokinetics of omalizumab could improve the success of omalizumab therapy. This review outlines the relationship between IgE-targeted therapy and the serum level of IgE to enhance the current understanding of the mechanism of omalizumab therapy. It also describes the clinical significance of measuring serum free IgE levels and monitoring omalizumab therapy.
Highlights
Immunoglobulin (IgE) was discovered by Ishisaka and his wife, Teruko, in 1968
In the Global Initiative for Asthma (GINA) guidelines, omalizumab is considered for the treatment of patients with the most severe type of asthma as an add-on therapeutic agent at step 5 of treatment; add-on treatment options for patients with uncontrolled severe asthma in step 4 of treatment
Omalizumab is indicated for severe atopic asthma, the extent to which IgE contributes to asthma in individual patients remains unclear
Summary
Immunoglobulin (IgE) was discovered by Ishisaka and his wife, Teruko, in 1968 Clinical trials examining the efficacy of omalizumab therapy have reported that there are limitations to the current diagnostic methods for atopic asthma based on serum IgE levels and intradermal reactions (Humbert et al, 1996; Menz et al, 1998; de Weck, 2002; Chung et al, 2014). Total serum IgE levels increase after omalizumab therapy compared to pre-administration levels This is attributed to the fact that the human serum half-life of IgE is relatively. Lowe and Renard (2011) presented a mathematical model based on the total serum IgE levels reported in 10 clinical trials to determine how those levels changed after several years of continuous omalizumab therapy. According to their model, total serum IgE levels gradually decreased with long-term omalizumab use.
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