Asthma is a disorder of the airways involving various inflammatory cells and mediators and characterised by bronchial hyperresponsiveness, chronic
inflammation and structural alterations in the airways, also known as remodelling.
IgE is an important mediator of
allergic reactions and has a central role in allergic
asthma pathophysiology, as it is implicated in both the early and late phase allergic response. Moreover, clinical and mechanistic evidence has lately emerged, implicating
IgE in the development of
airway remodelling. The use of
monoclonal antibodies targeting
IgE, such as
omalizumab, has proven very effective in improving respiratory symptoms and quality of life, while reducing
asthma exacerbations, emergency room visits and the use of systemic
corticosteroids in allergic severe
asthma. These effects are believed to be mainly mediated by
omalizumab's inhibitory effect on the initiation and further propagation of the allergic
inflammation cascade. However, there is evidence to suggest that
anti-IgE treatment remains effective long after it has been discontinued. In part, these findings could be attributed to the possible ameliorating effects of
anti-IgE treatment on
airway remodelling. In this review, we discuss recent findings supporting the notion that
anti-IgE treatment modulates the
complex immune responses that manifest clinically as
asthma and ameliorates
airway remodelling changes often observed in allergic severe
asthma phenotypes.