Abstract
Bronchial asthma is characterised by high levels of immunoglobulin E (IgE) and overproduction of pro-inflammatory cytokines, including interleukins IL-4, IL-13 and IL-5 needed for, amongst other things, the production of IgE and the differentiation, maturation, migration and survival of eosinophils. Eosinophils are one of the most important cells in allergic inflammation. Their presence in tissue is linked to the persistence of inflammatory infiltrate, tissue damage and remodelling. Although these cells are very sensitive to corticosteroids, some asthmatic patients do not respond to high doses of these drugs, even when administered systemically. Transbronchial biopsies and bronchoalveolar lavage performed in patients with steroid-resistant asthma have demonstrated higher levels of eosinophils and Th2-type cytokines (IL-4 and IL-5) compared to steroid-sensitive patients. Clinical studies have confirmed that the very effective treatment in these cases is therapy with omalizumab - an anti-IgE monoclonal antibody. The paper discusses the efficacy of omalizumab in reducing eosinophil number in peripheral blood and in the airways of asthmatic patients based on basic, clinical, observational studies and case reports. The significance of omalizumab therapy in asthma control and mechanisms that regulate the effects of omalizumab on eosinophils are evaluated.
Highlights
Asthma is an illness characterized by bronchial hyperreactivity, chronic inflammation and structural changes in the airways
In Massanari’s pooled analysis of five clinical trials [53] on the efficacy of omalizumab in patients with persistent moderate/severe allergic asthma, the post-treatment number of peripheral eosinophils compared to baseline was reduced only in the group of patients receiving omalizumab, with a greater reduction in eosinophil count observed in those in whom the serum free immunoglobulin E (IgE) levels were lower than 50 ng/ml
In addition to inhibition of the early and late allergic reaction associated with the activation of mast cells and basophils via FceRI, it affects chronic allergic inflammation, mainly through the reduction in eosinophilic infiltration
Summary
Asthma is an illness characterized by bronchial hyperreactivity, chronic inflammation and structural changes in the airways. Neutralization of free IgE by omalizumab and its effect on the expression and function of FceRI are reflected in clinical phenomena, such as inhibition of early [26, 27] and late phase of allergic reaction [28, 29] and a decrease in the severity of chronic allergic inflammation.
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