Pharmacological Management: Anti–Immunoglobulin E Therapy

David Naimi, MD

Introduction

•Immunoglobulin E (IgE) plays an important role in the pathogenesis of asthma and allergic diseases.

•Most asthmatic patients are atopic, with positive skin test findings for common allergens and detectable allergen-specific IgE in the serum.

•Exposure to allergens to which patients are sensitized can contribute to asthma symptoms.

•Anti-IgE therapy is a recombinant humanized immunoglobulin G1 monoclonal antibody that binds to IgE with high affinity.

•Omalizumab is the first U.S. Food and Drug Administration (FDA)– approved biological therapy for the treatment of asthma and the only available anti-IgE therapy. It is FDA approved for the treatment of allergic asthma and chronic urticaria.

—Decreases rates of asthma exacerbations, annualized rates of hospital admission, total emergency department visits, unscheduled doctor’s office visits, rescue therapy use, and inhaled corticosteroid dose.

—Improves symptom scores, quality of life, and time to first asthma exacerbation.

•More than 200,000 patients with allergic asthma have been treated with omalizumab since its approval in 2003 for people ≥12 years of age. It was approved in 2016 for people ≥6 years of age.

Mechanism of Action/Pharmacology

•Binds to circulating IgE, forming immune complexes that are subsequently cleared by the hepatic reticuloendothelial system.

•Inhibits the attachment of IgE to IgE receptors on mast cells, basophils, and other cell types, which reduces surface IgE receptor levels and the ability of these cells to be activated by allergens.

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