Matteo Bonini1, Giuseppe Di Maria2, Pierluigi Paggiaro3, Andrea Rossi4, GianEnrico Senna5, Massimo Triggiani6, Giorgio Walter Canonica7. 1. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. 2. Department of Clinical and Molecular Bio-Medicine, University of Catania, Catania, Italy. 3. Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy. 4. Pulmonary Unit, University and General Hospital, Verona, Italy. 5. Allergology Unit, University and General Hospital, Verona, Italy. 6. Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy. 7. Clinica Pneumologica e Allergologia, DIMI, Università di Genova, IRCCS AOU San Martino, Genoa, Italy. Electronic address: canonica@unige.it.
Abstract
OBJECTIVE: To provide an overview of primary and secondary mechanisms associated with anti-IgE therapy and their relation to other potential indications in diseases affecting the respiratory tract. DATA SOURCES: Literature from PubMed searches for publications providing insight into secondary mechanisms resulting from anti-IgE therapy and publications reporting on the use of omalizumab to treat conditions that affect the respiratory tract, other than severe atopic asthma. STUDY SELECTIONS: Clinical trials or case reports were identified for asthma in patients without atopy, allergic rhinitis, nasal polyposis, and allergic bronchopulmonary aspergillosis. RESULTS: There is substantial evidence from controlled trials supporting a benefit for allergic rhinitis. Case reports and series on more than 50 patients with allergic bronchopulmonary aspergillosis have been published, including patients with or without cystic fibrosis; most have reported benefits in terms of decreased steroid use, exacerbation rates, and, in patients with cystic fibrosis, improvement in lung function. Several small controlled studies on nasal polyposis have shown equivocal results. One small controlled trial in patients with nonatopic asthma showed a significant improvement for lung function but not in exacerbation rate or asthma scores. CONCLUSION: Recent insight into the immunopathology of respiratory diseases should be used to identify patient populations likely to respond to anti-IgE therapy. Controlled clinical trials are needed to confirm efficacy and determine the clinical significance of the effects of omalizumab in these populations.
OBJECTIVE: To provide an overview of primary and secondary mechanisms associated with anti-IgE therapy and their relation to other potential indications in diseases affecting the respiratory tract. DATA SOURCES: Literature from PubMed searches for publications providing insight into secondary mechanisms resulting from anti-IgE therapy and publications reporting on the use of omalizumab to treat conditions that affect the respiratory tract, other than severe atopic asthma. STUDY SELECTIONS: Clinical trials or case reports were identified for asthma in patients without atopy, allergic rhinitis, nasal polyposis, and allergic bronchopulmonary aspergillosis. RESULTS: There is substantial evidence from controlled trials supporting a benefit for allergic rhinitis. Case reports and series on more than 50 patients with allergic bronchopulmonary aspergillosis have been published, including patients with or without cystic fibrosis; most have reported benefits in terms of decreased steroid use, exacerbation rates, and, in patients with cystic fibrosis, improvement in lung function. Several small controlled studies on nasal polyposis have shown equivocal results. One small controlled trial in patients with nonatopic asthma showed a significant improvement for lung function but not in exacerbation rate or asthma scores. CONCLUSION: Recent insight into the immunopathology of respiratory diseases should be used to identify patient populations likely to respond to anti-IgE therapy. Controlled clinical trials are needed to confirm efficacy and determine the clinical significance of the effects of omalizumab in these populations.