Anti-IgE Therapy in Severe Allergic Asthma

Severe allergic asthma is characterised by persistent symptoms, frequent exacerbations and a high burden of medication, often driven by immunoglobulin E (IgE)-mediated pathways. Binding of allergen-specific IgE to high-affinity receptors on mast cells and basophils initiates a cascade of type 2 inflammation, airway hyper-responsiveness and remodelling. Anti-IgE therapy employs a humanised monoclonal antibody that selectively neutralises circulating IgE, preventing its attachment to cellular receptors and downregulating receptor expression. This approach has transformed management for patients whose disease remains uncontrolled despite optimised inhaled corticosteroids and long-acting bronchodilators. Clinically, anti-IgE treatment reduces exacerbation frequency, spares oral corticosteroid use, improves lung function and enhances quality of life. Real-world evidence has highlighted benefits in diverse healthcare settings, while ongoing research seeks to refine patient selection through biomarkers and to extend the therapeutic repertoire with novel IgE-targeting agents.

Research from Nature Portfolio

Longitudinal analyses have confirmed sustained benefits of anti-IgE therapy over extended periods. A comprehensive meta-analysis evaluated patients with persistent uncontrolled allergic asthma treated for at least one year. Findings demonstrated significant improvements in patient-reported quality of life and clinician-assessed global treatment effectiveness. Many patients were able to cease inhaled corticosteroids entirely without compromising symptom control. The safety profile remained acceptable, with no increase in serious adverse events over time. However, the impact on exacerbation rates was variable across studies, and cost-effectiveness analyses indicated that economic value is maximised when treatment is targeted to those with the most severe disease and highest baseline IgE levels.

Anti-IgE Therapy in Severe Allergic Asthma publication trend

The graph below shows the total number of articles in anti-ige therapy in severe allergic asthma across all publications each year (not limited to Nature Index journals).

Technical terms

Immunoglobulin E (IgE): A class of antibody that binds allergens and triggers allergic inflammation through high-affinity receptors on immune cells.

Omalizumab: A recombinant humanised monoclonal antibody that binds free IgE, preventing receptor engagement and downstream allergic responses.

Exacerbation: An acute or subacute worsening of asthma symptoms requiring additional treatment or hospitalisation.

Forced Expiratory Volume in 1 Second (FEV₁): A spirometric measure of the volume of air exhaled in the first second of a forced breath, reflecting airway calibre.

Biomarker: A measurable indicator of biological processes or treatment response, such as blood eosinophils or fractional exhaled nitric oxide.

References

1. Treating severe allergic asthma with anti-IgE monoclonal antibody (omalizumab): a review. Multidisciplinary Respiratory Medicine (2014).
2. Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis. Scientific Reports (2015).
3. Efficacy and safety of a proposed omalizumab biosimilar compared to the reference product in the management of uncontrolled moderate-to-severe allergic asthma: a multicenter, phase III, randomized, double-blind, equivalency clinical trial. Frontiers in Immunology (2024).
4. Impact of Omalizumab in Patients with Severe Uncontrolled Asthma and Possible Predictive Biomarkers of Response: A Real-Life Study. Pharmaceutics (2023).