Pediatric usage of Omalizumab: A promising one

Abstract

Allergic and related diseases have a substantial epidemiological impact on the pediatric population. Small molecule-based medicines have been traditionally used to manage the diseases. Omalizumab is the first monoclonal antibody-based medicine used in children's allergy and shows great promises. It binds to free IgE and prevents it from binding to IgE receptors, thus interrupting the IgE-dependent allergic inflammatory cascade. Vast amounts of data demonstrate its effectiveness and well tolerance by patients, including the children. However, the drug was only approved to use in allergic asthma and chronic spontaneous urticaria (CSU), though other applications were explored in clinical trials. In this review, we summarized current pediatric applications of omalizumab in allergic diseases, focusing on its usages beyond asthma and CSU, including allergic rhinitis, allergic bronchopulmonary aspergillosis, vernal keratoconjunctivitis, food allergy and atopic dermatitis. In addition, we highlighted the unmet needs and controversial issues of anti-IgE therapy.

Assessment of dupilumab in children with moderate‐to‐severe type 2 asthma with or without evidence of allergic asthma

“…Patients with evidence of allergic asthma demonstrated clinically meaningful responses to dupilumab treatment, supporting the role of IL‐4 and IL‐13, and thus type 2 inflammation, as key drivers of certain patients with allergic asthma. The position of dupilumab among other biologics in severe allergic pediatric asthma remains to be determined by comparative studies, aimed at identifying the most appropriate biomarkers of responsiveness 19,20 …”

Therapeutical Targets in Allergic Inflammation

“…Omalizumab is an IgG1κ humanized monoclonal antibody that binds free IgE, inhibiting the binding to high- and low-affinity IgE receptors (FcεRI and FcεRII, respectively), while dupilumab is an IgG4 human monoclonal antibody that binds the α subunit of the IL-4 receptor (IL-4Rα), one of the two subunits of the IL-4 and IL-13 receptors, respectively, thus inhibiting the signaling of both IL-4 and IL-13 [ 1 , 2 , 3 , 4 ]. Beyond the basic mechanisms of action, it is now known that both these monoclonal antibodies have pleiotropic effects in the control of allergic inflammation.…”

Biologics and severe asthma in children

“…For example, the ability of omalizumab to block the IgE-mediated immune response may lend itself well toward preventing the atopic march and asthma development. In fact, research is being directed to the use of omalizumab to prevent exacerbations during respiratory viral season in school children and adolescents and even to prevent the development in asthma in toddlers with early childhood wheeze [44 ▪ ,51,52,53 ▪ ].…”