Omalizumab: Un nuovo strumento terapeutico in dermatologia allergologica?

Translated title of the contribution: Omalizumab: A novel therapeutic tool in allergological dermatology?

Nicoletta Cassano, Michelangelo Vestita, Gino Antonio Vena

Research output: Contribution to journalArticle

Abstract

Omalizumab is a recombinant humanized monoclonal antibody directed against IgE. The pharmacological purposes of omalizumab are to neutralize serum IgE and to inhibit IgE production in order to attenuate hypersensitivity reactions. The therapeutic efficacy of this approach is attributable to several mechanisms, many of which are indirect and only partially known, although the mode of action of the drug appears to be very complex. Omalizumab has been found to be capable of downregulating the expression of high-affinity IgE receptors on basophils, mast cells and antigen presenting cells. The drug can also inhibit IgE production through the interaction with IgE-expressing B cells. Moreover, it leads to the accumulation of potentially beneficial IgE-anti-IgE immune complexes. Use of omalizumab is approved for the treatment of patients with moderate-to-severe persistent allergic asthma that is not controlled with high-dose inhaled corticosteroids. The efficacy in this condition is supported by the results of various phases II and III clinical trials. Randomized controlled studies also demonstrated omalizumab efficacy in the management of allergic rhino-conjunctivitis, while various reports indicated its potential usefulness in food allergy, latex allergy and mastocytosis. Furthermore, a synergic effect with specific immunotherapy has been revealed. Recent observations suggest that omalizumab might play an important role in the treatment of various conditions of dermato-allergological interest. In fact, there are reports on the efficacy of omalizumab in severe refractory cases of atopic dermatitis and chronic idiopathic urticaria, in addition to anecdotal observations regarding acquired cold urticaria, solar urticaria and cholinergic urticaria. In most of the patients in these conditions, disease activity improved and use of concomitant medications declined during treatment with omalizumab. Successful treatment of very few patients with idiopathic recurrent angioedema has also been reported. Further investigation is needed to fully understand the exact mechanisms responsible for the effectiveness of omalizumab in these conditions, as well as to establish criteria for patients' eligibility and recommended doses. Omalizumab is generally well tolerated, presenting only minor adverse effects, the most common being injection site reactions. Nonetheless, anaphylactic and/or anaphylactoid reactions have been sporadically described. A rare but well documented complication of omalizumab therapy is the development of Churg-Strauss vasculitis. In conclusion, the available data suggest a great potential of anti-IgE therapy in dermatoallergology, though large randomized controlled studies are required.

Translated title of the contributionOmalizumab: A novel therapeutic tool in allergological dermatology?
Original languageItalian
Pages (from-to)99-109
Number of pages11
JournalAnnali Italiani di Dermatologia Allergologica Clinica e Sperimentale
Volume63
Issue number3
Publication statusPublished - Sep 2008

ASJC Scopus subject areas

  • Dermatology
  • Immunology and Allergy

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