Bronchial asthma is recognized as a highly prevalent health problem in the developed and developing world with significant social and economic consequences. Increased
asthma severity is not only associated with enhanced recurrent hospitalization and mortality but also with higher social costs. The pathogenetic background of allergic-atopic
bronchial asthma is characterized by airway
inflammation with infiltration of several cells (mast cells, basophils, eosinophils, monocytes, and T-helper (Th)2 lymphocytes). However, in atopic
asthma the trigger factors for acute attacks and chronic worsening of bronchial
inflammation are aeroallergens released by pollens, dermatophagoides, and pets, which are able to induce an immune response by interaction with
IgE antibodies. Currently anti-inflammatory treatments are effective for most
asthma patients, but there are asthmatic subjects whose disease is not completely controlled by inhaled or systemic
corticosteroids and who account for a significant portion of the healthcare costs of
asthma. A novel therapeutic approach to
asthma and other allergic
respiratory diseases involves interference in the action of
IgE, and this antibody has been viewed as a target for novel immunological
drug development in
asthma.
Omalizumab is a humanized recombinant monoclonal
anti-IgE antibody approved for treatment of moderate to severe
IgE-mediated (allergic)
asthma. This non-anaphylactogenic
anti-IgE antibody inhibits
IgE functions, blocking free serum
IgE and inhibiting their binding to cellular receptors. By reducing serum
IgE levels and
IgE receptor expression on inflammatory cells in the context of allergic cascade,
omalizumab represents a new class of mast cells stabilizing drugs; it is a novel approach to the treatment of atopic
asthma.
Omalizumab therapy is well tolerated and significantly improves symptoms and disease control, reducing
asthma exacerbations and the need to use high dosage of inhaled
corticosteroids. Moreover,
omalizumab improves quality of life of patients with severe persistent allergic
asthma which is inadequately controlled by currently available
asthma medications. In conclusion
omalizumab may fulfil an important need in patients with moderate to severe
asthma.