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J Allergy Clin Immunol Pract. 2014 Sep-Oct;2(5):525-36.e1. doi: 10.1016/j.jaip.2014.03.010. Epub 2014 Jun 11.

Omalizumab in asthma: an update on recent developments.

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Service de Pneumologie University Paris-Sud, Inserm U999, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. Electronic address:
Department of Medicine, University of Wisconsin Medical School, Madison, Wis.
Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas.
Advanced Quantitative Sciences, Novartis Pharma AG, Basel, Switzerland.
Novartis Pharmaceuticals UK Limited, Clinical Research, Horsham, West Sussex, UK.
Translational Medicine, Respiratory Profiling, Novartis Pharma AG, Basel, Switzerland.
University of Southampton, Faculty of Medicine, Southampton General Hospital, Southampton, UK.


IgE is central to the pathophysiology of allergic asthma. Omalizumab, a humanized anti-IgE mAb, specifically binds free IgE and interrupts the allergic cascade by preventing binding of IgE with its high-affinity FcεRI receptors on mast cells, antigen-presenting cells, and other inflammatory cells. The clinical efficacy of omalizumab has been well documented in a number of clinical trials that involve adults, adolescents, and children with moderate-to-severe and severe allergic asthma. In these studies, omalizumab reduced exacerbations, asthma symptoms, inhaled corticosteroid and rescue medication use, and improved quality of life relative to placebo or best standard of care. Similar benefits have been reported in observational studies in "real-world" populations of patients. Results from recent pooled data from randomized clinical trials and from a large prospective cohort study provide reassurance about the long-term safety of omalizumab. Omalizumab dosing is individualized according to body weight and serum-IgE level, and recent adjustments to the dosing algorithm in Europe have enabled more patients to be eligible for treatment. Ongoing and future research is investigating the optimal duration of therapy, accurate predictors of response to treatment, and efficacy in nonatopic asthma as well as other IgE-mediated conditions.


Allergic asthma; Anti-IgE; Exacerbations; Omalizumab

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