The pathogenetic aspect of allergic
bronchial asthma is characterized by airway
inflammation with infiltration of mast cells, basophils, eosinophils, monocytes and T-helper (Th)2 lymphocytes. Most cases of
asthma are atopic in nature and aeroallergens such as those released by pollens, Dermatophagoides, moulds etc, act as sensitizer and trigger agents which induce immune response through
immunoglobulin E (
IgE).
IgE is the key mediator of allergic inflammatory reaction and plays a central role in the pathogenesis of atopic-allergic diseases such as those of respiratory tract:
rhinitis and
bronchial asthma. Currently antiinflammatory and bronchodilation treatments, with integration of other drugs such as antileucotrienes, are effective for most of
asthma patients, but there are asthmatic subjects whose disease is incompletely controlled by inhaled or systemic
corticosteroids and these patients account for about 50% 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
IgE has been viewed as a target for novel immunological
drug development in
asthma.
Monoclonal antibodies are a molecule able to interact with specific
antigens and represent a very interesting options for
asthma treatment and their patents.
Omalizumab is a humanized recombinant monoclonal
anti-IgE antibody developed for the treatment of allergic diseases and with clear efficacy in adolescent and adult patients with moderate-to-severe allergic
asthma. This non-anaphylactogen
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 therapy is well tolerated and significantly improves symptoms, reducing
asthma exacerbations and the need to use high dosage of inhaled
corticosteroids to control disease. Moreover,
omalizumab improves quality of life of patients with severe persistent allergic
asthma that is inadequately controlled by currently available
asthma medications. In conclusion
omalizumab represents a really new approach to the treatment of atopic
asthma and may fulfil an important need in patients with moderate-to-severe
asthma.