Immunoglobulin E-mediated airway inflammation is active in most patients with asthma.
OBJECTIVE
To review the role of immunoglobulin E (IgE)-mediated inflammation in the pathogenesis of asthma, limitations of standard therapies, and IgE as a logical target for therapy with omalizumab aimed at attaining asthma symptom control.


METHODS
Review of worldwide scientific literature on the role of IgE-mediated inflammation in patients with asthma, supplemented with a clinical case study.


CONCLUSIONS
Clinical trials point to an important role for IgE blocker therapy as an add-on to current therapy to reduce exacerbations and corticosteroid use and to improve quality of life in patients with moderate-to-severe asthma. Omalizumab, a monoclonal antibody that binds IgE, has been shown to be an effective, well-tolerated treatment in these patients.


CONCLUSIONS
A significant number of patients with moderate-to-severe asthma do not achieve asthma symptom control, despite adhering to current guidelines-based standards of therapy, including the use of inhaled corticosteroids, beta-agonists, and leukotriene modifiers. None of these therapies directly addresses IgE-mediated inflammation. Therefore, patients with persistent symptoms of moderate-to-severe asthma should be evaluated and considered for therapy with the IgE blocker omalizumab.
Hayden
Mary Lou
ML
School of Nursing, University of Virginia, Richmond, Virginia, USA. mlhayden@vaallergy.com
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000276:immunology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000276:immunology / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001249:Asthma / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D007073:Immunoglobulin E / Q000187:drug effects / Q000276:immunology; D007249:Inflammation; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008407:Mast Cells / Q000276:immunology; D009722:Nurse Practitioners; D000069444:Omalizumab; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D020024:Leukotriene Antagonists; D000069444:Omalizumab; D007073:Immunoglobulin E