Effects of omalizumab, a humanized monoclonal anti-IgE antibody, on nasal reactivity to allergen and local IgE synthesis.
BACKGROUND
Treatment with omalizumab has been shown to reduce serum free IgE concentrations and to have beneficial effects on allergic airway disease. However, its effect on IgE synthesis is unknown.


OBJECTIVE
To determine whether omalizumab therapy affects nasal reactivity to allergen and local IgE production.


METHODS
Nineteen patients with perennial allergic rhinitis were treated with intravenous omalizumab every 2 weeks for 26 weeks in an open-label study. Serum free and total IgE concentrations were measured at baseline and every 2 weeks throughout the study. Nasal challenge to dust mite allergen was performed at baseline and after 12 and 24 weeks of treatment. Nasal lavage fluid obtained before and after each nasal challenge was evaluated for mite-specific antibodies, plaque-forming cells, and productive epsilon messenger RNA (mRNA).


RESULTS
During treatment, serum free IgE concentrations were decreased by 97% to 99%, and the nasal response to allergen challenge was significantly reduced on days 80 and 164. The postchallenge increase in nasal lavage mite specific IgE was significantly reduced by treatment with omalizumab on day 168. IgE plaque-forming cells and productive epsilon mRNA were not significantly affected by omalizumab treatment.


CONCLUSIONS
Omalizumab treatment markedly reduced serum free IgE and the clinical response to nasal allergen challenge. However, the absence of an effect on IgE-secreting B cells and epsilon mRNA in nasal lavage fluid suggests that omalizumab treatment for 6 months does not significantly modulate synthesis of nasal IgE.
Allergy Research Foundation, Los Angeles, California 90025, USA. joncorren@hotmail.com
Jonathan
J
Corren
David
D
Diaz-Sanchez
Andrew
A
Saxon
Yamo
Y
Deniz
James
J
Reimann
Don
D
Sinclair
Teresa
T
Davancaze
Daniel
D
Adelman
D000328:Adult; D000485:Allergens; D000818:Animals; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000918:Antibody Specificity; D001402:B-Lymphocytes / Q000276:immunology; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007073:Immunoglobulin E / Q000096:biosynthesis* / Q000097:blood / Q000235:genetics; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017817:Nasal Lavage Fluid / Q000276:immunology*; D009299:Nasal Provocation Tests; D000069444:Omalizumab; D039981:Pyroglyphidae / Q000276:immunology; D012333:RNA, Messenger / Q000097:blood; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D016896:Treatment Outcome
D000485:Allergens; D018926:Anti-Allergic Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D012333:RNA, Messenger; C026408:anti-IgE antibodies; D000069444:Omalizumab; D007073:Immunoglobulin E