Advances in therapeutic immunomodulation of IgE-mediated respiratory disease.
IgE is responsible for activation of allergic reactions and is important to the pathogenesis of allergic diseases and the development and persistence of airway inflammation. Clinical evidence strongly supports the efficacy and safety of SLIT for the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma and stinging insect hypersensitivity. Practice parameters help to guide the use of immunotherapy in conjunction with other pharmacologic and nonpharmacologic approaches. Allergy immunotherapy should be considered in patients with poor symptom control or adverse effects resulting from medications. In the US, subcutaneous immunotherapy remains the preferred form of immunotherapy. Its major advantages over sublingual immunotherapy appear to be efficacy and FDA approval, whereas SLIT seems to hold the promise of being safer and more convenient. If clinical trials with SLIT prove successful, an FDA-approved formulation will expand treatment choices; but for now, SLIT should be considered investigational. Whereas immunotherapy was first introduced over one century ago, the monoclonal anti-IgE antibody, omalizumab was introduced in 2004. Omalizumab works by nonspecifically inhibiting the IgE-mediated inflammatory cascade before it starts. FDA approval is currently limited to adults and adolescents (aged > or = 12 years) with moderate-to-severe persistent allergic asthma. Omalizumab's expense can limit patients' access. Access to care is critical if the goals of the EPR-3 Asthma Guidelines are to be met. The Rhode Island Department of Health, in collaboration with community programs, the health care community, and policy makers produced The Asthma Control State Plan 2003-2008. With support by the State and other agencies, together with the implementation of the comprehensive management approach outlined in the EPR-3 Asthma Guidelines, there is good reason for hope that in Rhode Island, our most severe asthma patients will achieve control of their disease with reduction in asthma risk, morbidity and mortality.
Settipane
Russell A
RA
Allergy & Asthma Center, Warren Alpert Medical School, Brown University, Providence, RI 02906, USA. Setti5@aol.com
D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications* / Q000628:therapy; D007073:Immunoglobulin E / Q000378:metabolism*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D000069444:Omalizumab; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D016756:Immunoglobulins, Intravenous; D000069444:Omalizumab; D007073:Immunoglobulin E