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Panminerva Medica 2012 December;54(4):305-12

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

The anti-IgE antibody omalizumab as a probe to investigate the role of IgE in pathology

Mauro M. ¹, Incorvaia C. ², Formigoni C. ³, Elia R. ², Russello M. ¹, Pellegrino D. ⁴ ✉

¹ Allergy Unit, Sant’Anna Hospital, Como, Italy; ² Allergy and Pulmonary Rehabilitation Unit, Istituti Clinici di Perfezionamento, Milan, Italy; ³ Scientific Library, Sant’Anna Hospital, Como, Italy; ⁴ Medical Department, Sant’Anna Hospital, Como, Italy

The immunoglobulin E (IgE) are a key factor in the pathophysiology of allergic diseases and the important therapeutic role of an anti-IgE antibody was long envisioned. It took time and efforts to solve the safety problems related to the anaphylactogen capacity of anti-IgE, finally crowned by the introduction of the humanized, monoclonal anti-IgE antibody omalizumab. Currently, omalizumab is indicated, based on clear evidence of efficacy, only in severe allergic asthma not controlled by conventional treatment. However, a continuously increasing amount of literature shows that omalizumab is efficacious in a number of disorders concerning the upper and lower airway and the skin, and, most importantly, in anaphylaxis. The latter application was demonstrated successful in placebo-controlled trials and warrants for a new, life-saving, indication for omalizumab. Also, the systemic reactions precluding the performance of allergen immunotherapy, especially concerning Hymenoptera venom, were prevented by omalizumab treatment. The most surprising success of omalizumab regards clinical conditions thus far considered unrelated to IgE antibodies. This is true for intrinsic asthma and for idiopathic urticaria (demonstrated by a placebo-controlled trial), and angioedema, suggesting in these condition a pathophysiologic role of IgE. These observations support a off-label use of omalizumab in patients suffering from IgE-related pathologies other than asthma who are at risk of fatal events or are uncontrolled by the optimal standard treatment.