Omalizumab : When and to whom

Immunoglobulin E plays a central role in the pathogenesis of asthma. Omalizumab is a recombinant humanised monoclonal antibody directed against Immunoglobulin E to inhibit the immune system's response to allergen exposure. Omalizumab binds to free Immunoglobulin E decreasing cell-bound Immunoglobulin E and reduces high-affinity receptors on mast cells and basophils blocking the allergic cascade at its primary step. Approximately 20% of asthma patients have severe asthma, 20% are uncontrolled and 50% have allergic asthma, and about 2% of asthmatic patients would be eligible for anti-Immunoglobulin E treatment. Uncontrolled asthma remains a major issue. In fact, despite inhaled corticosteroid (ICS) or ICS plus long-acting β2-agonist therapy, 72% of patients are uncontrolled or not well controlled according to the Asthma Control Questionnaire. Omalizumab as add-on therapy reduces exacerbations, need of emergency visits and systemic steroid administration, and hospitalizations, Finally, omalizumab is generally well tolerated.