Search

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is a condition characterized by the triad of chronic rhinosinusitis with nasal polyps, bronchial asthma, and hypersensitivity to nonsteroidal anti-inflammatory drugs. This article explores the current knowledge on the various pathological mechanism(s) of N-ERD-such as arachidonic acid metabolism, cysteinyl leukotrienes, prostaglandins, platelets, IgE, mast cells, eosinophils, basophils, and innate immune system-and the role of omalizumab in its management. The authors dive deep into the role of IgE in N-ERD and its potential as a therapeutic target. IgE plays a significant role in mediating allergic reactions, is intricately linked with mast cells, interacts with multiple immunopathological pathways involved in N-ERD, and tends to be elevated in patients with N-ERD. Multiple real-world studies, observational studies, and case series, as well as 2 phase III trials, have demonstrated the effectiveness of omalizumab in the management of N-ERD. For a disease with such a well-documented history, the pathophysiology of N-ERD and the most effective ways to manage it remain a mystery. With this background, the authors ask-is IgE a missing piece of the N-ERD puzzle, thus explaining the efficacy of omalizumab in the treatment of the disease?

An unmet clinical need exists in the management of treatment-refractory allergic bronchopulmonary aspergillosis (ABPA). Omalizumab has shown promising effects in case series and cohort studies; however, evidence to support its routine clinical use is lacking.The aim of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of omalizumab in patients with ABPA.A systematic search across standard databases was conducted using specific keywords until May 13, 2021. A meta-analysis was performed to compare the effectiveness (exacerbations, oral corticosteroid [OCS] use, lung function, patient-reported asthma control) and safety of pre- and post- omalizumab treatment. Subgroup analyses were performed for treatment duration and underlying disease.In total, 49 studies (n=267) were included in the qualitative synthesis and 14 case series (n=186) in the quantitative meta-analysis. Omalizumab treatment significantly reduced the annualized exacerbation rate versus pre-treatment (mean difference [MD]: -2.09 [-3.07; -1.11], P0.01). There was a reduction in the OCS use (risk difference [RD]: 0.65 [0.46;0.84], P0.01), an increase in termination of OCS use (RD: 0.53 [0.24;0.82], P0.01), and a reduction in OCS dose (mg/day) (MD: -14.62 [-19.86; -9.39]; P0.01) in ABPA patients receiving omalizumab. Omalizumab improved forced expiratory volume in 1 second (FEV1) % predicted by 11.9% (8.2; 15.6, P0.01) and asthma control, and was well tolerated.Omalizumab treatment reduced exacerbations and OCS use and improved lung function and asthma control in patients with ABPA and was well tolerated. The results highlight the potential role of omalizumab in the treatment of ABPA.

Immunoglobulin E (IgE) plays an essential role in many allergic diseases. This review highlights the role of IgE in atopic dermatitis (AD), a common, chronic, and complex skin inflammation, and the available therapeutic approaches that target IgE in AD. We examine the existing data showing the use of omalizumab, the only biologic anti-IgE therapy available in clinical use, plasma apheresis, and a combination of both therapeutic approaches for the treatment of AD. Existing data on the efficacy of omalizumab in AD are inconclusive. A limited number of randomised controlled studies, few uncontrolled prospective and retrospective reports, as well as multiple case series and case reports observed varying degrees of the efficacy of omalizumab in AD. Omalizumab displays a trend of higher efficacy in AD patients with low IgE levels compared with those with very high-to-extremely high serum IgE concentrations. Plasma apheresis and its combination with omalizumab show good efficacy, even in patients with unusually high serum IgE concentrations. Combining apheresis and anti-IgE treatment may serve as a comprehensive therapeutic approach for patients with elevated levels of IgE. Dedicated clinical studies with robust study designs are needed to establish the therapeutic efficacy of omalizumab in AD.