Omalizumab

Persson GB, Chung KF, Bousquet J. Kerstjens HA, Fox H, Thirlwell J, Cioppa GD Efficacy and safety of a recombinant anti-immunoglobulin E antibody (omalizumab) in severe allergic asthma. Clin Exp Allergy 2004 34 632-638. 

Shapiro GG, Metcalfe DD Omalizumab for the treatment of unprovoked anaphylaxis in patients with systemic mastocytosis. J Allergy Clin Immunol 2007 119 1550-1551. 

MH, Townley RG. Mokhtarani M. Seyfert-Margohs V, Asare A. Bateman K. Deniz Y Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 2006 117 134-140. 

In rare cases, initiation of specific immunotherapy with insect venom leads to recurrent anaphylaxis, even with antihistamine premedication. In those cases, comedication with omalizumab (anti-IgE) has been reported to induce tolerance. In a case of recurrent anaphylaxis to induction of specific immunotherapy, the injection of 300 mg of omalizumab between 4 days and 1 h reportedly led to tolerance [42]. This approach also appears worthy of consideration in patients with both idiopathic recurrent anaphylaxis and mastocytosis who do not respond to standard antimediator therapy, as has been described in 2 atopic patients with ISM [43]. Most patients with mastocytosis and idiopathic anaphylaxis, however, are sufficiently controlled by standard antimediator therapy with antihistamines with or without low-dose corticosteroids. 

Kontou-Fili K High omalizumab dose controls recurrent reactions to venom immimotherapy in indolent systemic mastocytosis. Allergy 2008 63 376-378. 

Omalizumab is a recombinant humanized monoclonal anti-IgE antibody that inhibits binding of IgE to receptors on mast cells and basophils, resulting in the inhibition of mediator release and attenuation of the early- and late-phase allergic response. It may be a treatment option for moderate to severe persistent asthmatics 12 years of age or older whose asthma is not controlled by inhaled corticosteroids and who have a positive skin test or in vitro reactivity to perennial allergens.37 Omalizumab significantly decreases inhaled corticosteroid use, number and length of exacerbations, and increases asthma-related quality of life.37... 

Clinical trials have indicated that omalizumab, a recombinant humanized monoclonal IgE antibody approved for use in moderate to severe persistent asthma in patients with reactivity to a perennial allergen, is effective in the treatment of SAR.25-27 Omalizumab inhibits the binding of IgE to mast cell and basophil receptors, resulting in a reduction of allergic mediator release.25 Additionally, serum free IgE levels are decreased.2 27 In SAR patients, omalizumab improves quality of life and nasal symptoms and reduces antihistamine needs. The most effective dose in SAR appears to be omalizumab 300 mg administered subcutaneously every 3 to 4 weeks depending on baseline IgE levels.26,27... 

The most common adverse effect with omalizumab is injection-site reaction, reported in 45% of patients in clinical trials. Other adverse effects include viral and upper respiratory tract infections, sinusitis, headache, and pharyngitis. Rare cases of malignant neoplasms and anaphylaxis were reported during clinical trials of omalizumab in asthma. Patients should be monitored for at least 2 hours following the injection so that anaphylaxis and/or injection-site reactions may be managed.25... 

Omalizumab is substantially more costly than other AR treatment options and must be administered in the clinic setting.28 Comparative trials are needed to determine the role of omalizumab in AR. 

Xolair (omalizumab humanized monoclonal Genentech/Novartis/ Treatment of adults/adolescents... 

Omalizumab (Xolair) is an anti-IgE antibody approved for the treatment of allergic asthma not well controlled by oral or inhaled corticosteroids. The dosage is determined by the patient s baseline total serum IgE (international units/mL) and body weight (kg). Doses range from 150 to 375 mg given subcutaneously at either 2- or 4-week intervals. 

Atopic dermatitis has been proposed to be the cutaneous manifestation of IgE-mediated hypersensitive reaction to allergenic substances [29]. Conceptually, antagonizing IgE emerges as a logical therapeutic option. Systemic treatment with omalizumab, however, appears to be less efficacious in the skin than in the airway mucosa [23]. It is possible that small molecule Syk inhibitors may offer a more suitable mode to reach and prevent activation of sensitized dermal mast cells and dendritic cells. 

Q53 Before initiating treatment with omalizumab, body weight and immunoglobulin E concentration need to be determined. Omalizumab is a monoclonal antibody administered by subcutaneous injection for the prophylaxis of allergic asthma. 

Omalizumab is a monoclonal antibody that binds to immunoglobulin E. It is used as additional therapy in asthma patients who have a proven IgE-mediated sensitivity to inhaled allergens and who are presenting with severe, persistent, uncontrolled asthma. It is administered by subcutaneous injection and the dose is calculated based on the immunoglobulin E concentration and body weight. 

In addition to the small molecular weight drugs, various antibodies (adalimumab, ritux-imab, omalizumab), a recombinant form of human IL-l-receptor antagonist (anakinra) and a recombinant fusion protein comprising the... 

Winchester D, Jacob A, Murphy T, Tonnel A, Tillie-Leblond 1. Omalizumab for asthma. N Engl J Med 2006 355 1281-2. 

Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of omalizumab therapy... 

Immediate improvement in asthma symptoms may not be apparent after beginning omalizumab therapy... 

Patient should be observed after injection of omalizumab, and medications for the treatment of severe hypersensitivity reactions, including anaphylaxis, should be available... 

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