Use of omalizumab (Xolair) anti-IgE therapy beyond asthma

Multiple studies have demonstrated the efficacy and safety of the monoclonal anti-IgE antibody omalizumab (Xolair) in treating patients with asthma. Omalizumab binds to Cε3 region of IgE.

The use of omalizumab for other allergic diseases has been demonstrated in small studies and case reports:

- Allergic rhinitis - effective

- Immunotherapy - adds safety to immunotherapy

- Food allergy - effectiveness shown with different formulation of anti-IgE (TNX-901) than omalizumab

- Atopic dermatitis - conflicting evidence. Serum IgE levels are typically increased in atopic dermatitis - there is often difficulty in significantly reducing extremely increased IgE levels.

- Chronic urticaria/angioedema Idiopathic, autoimmune, cholinergic, cold induced. Approximately 50% of patients with chronic urticaria have an autoimmune component. Case reports show promise but there is no conclusive evidence.

- Nasal polyposis/sinusitis - improvement of edema

- Eosinophilic gastrointestinal diseases - decreased serum eosinophil counts and improved symptoms

- Drug allergy - one case report of insulin allergy

References:
Anti-IgE therapy: Clinical utility beyond asthma. Thomas B. Casale, Jeffrey Stokes. Volume 123, Issue 4, Pages 770-771.e1 (April 2009).
Single-dose omalizumab (300mg) in patients with H1-antihistamine–refractory chronic idiopathic urticaria leads to improvement within 1-2 weeks. JACI, 2011.

Single dose of omalizumab (one 300 mg injection) relieves chronic idiopathic urticaria refractory to H1-antihistamines. Medscape, 2011.

Down regulation of high-affinity IgE receptor in successful treatment of chronic idiopathic urticaria with omalizumab http://goo.gl/cHKjJ
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