Omalizumab therapy for children and adolescents with severe allergic asthma

Abstract

Omalizumab, a therapeutic humanized monoclonal antibody specific for human IgE, was introduced in clinical practice more than a decade ago as an add-on therapy for moderate-to-severe allergic asthma in patients aged ≥12 years. Omalizumab has been demonstrated to be effective in adults with uncontrolled persistent asthma, with an excellent safety profile. In simple terms, omalizumab works by inhibiting the allergic cascade, that is, by neutralization of the circulating free IgE. This leads to reduction in the quantity of cell-bound IgE, downregulation of high-affinity IgE receptors, and, eventually, prevention of mediator release from effector cells. Evidence is far less abundant on the role of omalizumab in pediatric asthma. Although efficacy and safety of omalizumab in children and adolescents with uncontrolled, persistent allergic asthma has been recognized as well, further studies are needed to clarify a number of open questions in this specific patient population.

Keywords:

• adolescents
• anti-IgE
• asthma
• children
• omalizumab

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A high burden of disease exists for children with severe allergic asthma.

• Omalizumab, a humanized monoclonal antibody targeting IgE, has been shown to be effective as add-on therapy in adults with uncontrolled allergic asthma.

• Omalizumab for moderate-to-severe allergic asthma appears to be as safe and effective in the pediatric and adolescent population as in adults although evidence is less abundant.

• The mechanism of action of omalizumab is still incompletely understood; elucidation of the pleiotropic effects exerted by omalizumab may help select asthma phenotypes susceptible to significant clinical responses.

• Further research is needed to shed light on several unresolved clinical issues in the pediatric and adolescent population, such as optimal duration of therapy, identification of predictors of response, long-term safety.

• Up to one-third of children and adolescents on high-intensity treatment for severe allergic asthma still cannot receive omalizumab because their serum total IgE levels lie beyond the upper limit of the current dosing schedule.

• It remains to be determined whether omalizumab may have a therapeutic role even in nonallergic asthma.

Notes