Omalizumab for severe asthma: toward personalized treatment based on biomarker profile and clinical history

Figures & data

Figure 1 Complex cross talk in T2 high inflammation.

Notes: Epithelial cells secrete TSLP, IL33, and IL25, which stimulate mast cells, and T_H2 and ILC2. T_H2 and ILC2 cells share many features, and both are involved in the secretion of type 2 cytokines, including IL4, IL13, and IL5. B cells undergo class switch under the influence of IL4, increasing production of IgE. IL13 affects smooth muscles and airway remodeling. IL5 contributes to the production and migration of eosinophils to the site of inflammation. Data from Galli and Tsai¹³ and Lambrecht and Hammad.⁴⁹

Figure 2 Omalizumab causes a decrease in serum free IgE.

Notes: The IgE decrease subsequently impacts expression of FcεRI on surfaces of mast cells, basophils, dendritic cells, and eosinophils. This causes decreased activation of mast cells and basophils. Cross talk between dendritic and naïve T cells is decreased, impacting the shift toward T_H2 cells. Data from Kupryś-Lipińska et al.⁵⁰

Figure 3 A way to categorize patients with moderate–severe asthma in clinical settings using available biomarkers.

Note: *FeNO >50 ppb (>35 ppb in children) or rising FeNO (>40% change from previously stable levels) is associated with possible uncontrolled inflammation, poor inhaler use, or steroid resistance.
Abbreviation: FeNO, fractional exhaled nitric oxide.

GalliSJTsaiMIgE and mast cells in allergic diseaseNat Med2012185693704

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LambrechtBNHammadHThe immunology of asthmaNat Immunol20151614556

 Web of Science ®Google Scholar

Kupryś-LipińskaIMolińskaKKunaPThe effect of omalizumab on eosinophilic inflammation of the respiratory tract in patients with allergic asthmaPneumonol Alergol Pol2016844232243

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