The Relevance of IgE in the Pathogenesis of Allergy: The Effect of an Anti-IgE Drug in Asthma and Other Diseases

Abstract

The frequency of allergic diseases has increased in recent decades. Asthma is one of the most prevalent conditions and a leading cause of morbidity. It affects 3-4% of the population in our geographical setting and extrinsic allergens are detected as the disease's etiological agent in around half of these cases. IgE is one of the molecules involved in the allergic process. Most of the time and resources at asthma units are devoted to corticosteroid-dependent patients. International guidelines for asthma treatment recommend a stepwise therapeutic approach; in the last step, the use of oral corticosteroids is advised when control is not achieved with long-acting beta-2-agonists and high doses of inhaled corticosteroids. No alternatives or complements to oral corticosteroids had been proposed until November 2006, when the latest GINA update included the IgE blocker omalizumab in the last step of asthma treatment. In this paper we discuss the pathogenesis of the allergic reaction and the key importance of IgE in this process in order to highlight the beneficial effects of a drug able to block the circulation of the free form of this immunoglobulin. We also review the most important studies and patents for the efficacy and effectiveness of the drug in the treatment of adults and pediatric patients with asthma and other diseases.

Dual Monoclonal Antibody Therapy for a Severe Asthma Patient

“…The patient was administered sub-cutaneous (sc) omalizumab at a dose of 300 mg/month, in accordance with the dosing table (Domingo et al, 2007). After 16 weeks of treatment, she reported a mild improvement and the treatment was maintained.…”

“…Until omalizumab was first marketed in 2006, the international guidelines considered oral corticosteroids (OCs) to be the final step in the treatment of severe asthma patients (Domingo et al, 2007). The use of certain immunosuppressive drugs was also proposed (Domingo et al, 2009;Domingo et al, 2011a) although they were not included in the guidelines.…”

The prostaglandin D2 receptor 2 pathway in asthma: a key player in airway inflammation

“…Inhaled antigens are presented to CD4 + T lymphocytes by allergen presenting cells. In allergic patients, these T lymphocytes differentiate to acquire a T H 2 cell profile, producing significant amounts of IL-4 and IL-13, which promote IgE class-switching in B lymphocytes [ 21 – 23 ]. Mast cells are subsequently activated upon allergen-induced cross-linking of adjacent high-affinity IgE Fc receptor (FcεRI)-bound IgE at the cell surface [ 24 ].…”

The Incredible Adventure of Omalizumab

“…All of this was linked to the development of new drugs known as biologics (so called because they were originally obtained from live Chinese hamster cells) or monoclonal antibodies (mAbs) [ 1 ]. Thanks to the knowledge obtained from the administration of immunotherapy for allergy, IgE took on special importance at the beginning of this process [ 2 ]. It was seen that the allergic process began with the activation of dendritic cells or antigen-presenting cells (APCs).…”