Novel
therapies that interfere specifically with immunologic mechanisms underlying
allergen-induced pathology are currently in clinical evaluation. Among these is
anti-IgE, which directly targets
IgE serum
antibodies, thus inhibiting the central mechanism of immediate-type
hypersensitivity reactions. Application of
anti-IgE antibodies effectively reduces
IgE serum levels regardless of
allergen specificity.
Anti-IgE therapy has been successfully tested in patients with
allergic rhinitis,
asthma, and
food allergy, showing significant efficacy in reducing symptom scores and the use of rescue medications. However, such
therapy is limited by high costs and the requirements for permanent or every-season treatment. The advantage of specific
immunotherapy (SIT) is the potential to alter the course of the disease, which has been demonstrated in patients with
allergic rhinitis,
insect venom allergy and, to a lesser degree,
asthma. The broader application of SIT is restricted by sometimes life-threatening adverse effects. The combination of
anti-IgE with SIT was suggested to be superior to each single treatment protocol in children and adolescents with
allergic rhinitis. In a randomized, double-blind trial to assess the efficacy and safety of
anti-IgE (
omalizumab) or placebo in combination with SIT (birch pollen or grass pollen), the combination
therapy reduced symptom load, the sum of daily symptom severity score plus rescue medication use, over the birch and grass pollen seasons by nearly 50% over SIT alone. These data show that the combination of
anti-IgE plus SIT may be beneficial for the treatment of allergic diseases, offering improved efficacy, limited adverse effects, and potential immune-modifying effects.