Treatment with Anti-IgE Monoclonal Antibody and Free IgE

  • Hisako MatsumotoEmail author
Part of the Respiratory Disease Series: Diagnostic Tools and Disease Managements book series (RDSDTDM)


Treatment with omalizumab, a monoclonal anti-IgE antibody, significantly reduces asthma symptoms, frequency of reliever use, and severe asthma exacerbations while improving pulmonary function in patients with severe allergic asthma who experience inadequate control with high doses of inhaled corticosteroids and other controllers. Airway tissue measurements and computed tomography have also shown that omalizumab treatment improves airway remodeling. In addition, omalizumab may augment protective effects against rhinovirus infection by potentially improving type I interferon production. Comorbidities related to severe asthma, such as eosinophilic chronic rhinosinusitis, allergic bronchopulmonary aspergillosis, and aspirin-exacerbated respiratory diseases, also respond to omalizumab treatment. Thus, omalizumab has introduced a new era for the management of severe asthma. However, given the heterogeneous nature of severe asthma, responses to omalizumab vary in patients with severe allergic asthma. Better responses to omalizumab are expected in patients with type 2-high inflammation who show higher levels of exhaled nitric oxide, blood eosinophils, and serum periostin. Lastly, the optimal duration of omalizumab treatment remains unknown, though discontinuation of omalizumab after a 5-year treatment period yielded significantly worse outcomes for asthma control than continuation thereof. Subsequently, higher blood eosinophil counts have been suggested to predict failure after treatment discontinuation.


Omalizumab Type 2 inflammation Free IgE 


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Respiratory MedicineKyoto University of Graduate School of Medicine, Kyoto UniversityKyoto CityJapan

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