THE COMBINATION OF ANTI-IGE THERAPY AND SPECIFIC IMMUNOTHERAPY FOR THE TREATMENT OF ALLERGIC DISEASES
Tse Wen Chang
Genomics Research Center, Academia Sinica, Taiwan
The anti-IgE antibody, omalizumab (trade name Xolair), has been approved in more than 90 countries for treating patients with severe, persistent allergic asthma and shown in more than 100 clinical trials to be efficacious and safe for treating many other allergic diseases. Omalizumab is not a merely chemical blocker inhibiting the binding of IgE to the high-affinity IgE.Fc receptors (FcεRI) on mast cells and basophils. It has multiple immunoregulatory effects, e.g. it can down-regulate FcεRI on mast cells and basophils, lyse membrane-bound IgE-expressing B cells, and lower the levels of many inflammatory cytokines and hence the overall inflammatory state. Because omalizumab can intercept the IgE-mediated allergic pathway and inhibit anaphylactic reactions, it has been studied for enhancing the therapeutic efficacy and safety of specific immunotherapy. In several phase II trials, omalizumab has been shown to enable the acceleration of dosing schedule and the reduction of treatment time to achieve efficacy, while reducing markedly the rate of anaphylactic incidences. Omalizumab can also provide similar benefits in rush immunotherapy and oral immunotherapy. Furthermore, the combination of omalizumab and specific immunotherapy potentially offers the ultimate therapeutic goal, i.e. a cure or a long-lasting remission state.