Review Topic
  • An 11-year-old boy with a history of asthma presents to the allergist’s office with an increasing frequency of needing to use his rescue inhaler. He uses medium-dose fluticasone/salmeterol daily, but for the last week has needed to use his albuterol twice a day and once at night to keep his breathing comfortable. On exam, he is breathing comfortably but has diffuse wheezes throughout the bilateral lungs upon auscultation. An allergen skin test is positive for multiple year-round allergens. The allergist steps up the patient’s asthma diagnosis and prescribes him omalizumab. (Moderate-to-severe persistent asthma)
  • One of 7 medications used for asthma aimed to reduce inflammation and obstruction  
    • corticosteroids
    • β-agonists
    • muscarinic agonists
    • methylxanthines   
    • cromolyn
    • antileukotrienes 
    • omalizumab
  • Mechanism of action
    • monoclonal antibody against IgE
      • binds and inhibits free serum IgE
    • IgE is involved in bronchoconstriction and recruitment of inflammatory cells to combat allergens
      • therefore, omalizumab lessens these responses
  • Clinical uses
    • moderate-to-severe persistent asthma
      • symptoms must be inadequately controlled on inhaled corticosteroids
      • must have IgE-mediated allergy to at least 1 year-round allergen, proven by allergen skin test
      • must have elevated serum IgE levels
    • chronic idiopathic urticaria
  • Adverse effects
    • hypersensitivity reactions
      • local injection site reactions
      • urticaria
      • anaphylaxis
        • 1-2 out of 1000
    • serum sickness-like reaction
      • very rare, only case reports
      • treatment
        • discontinue omalizumab and give antihistamines
        • glucocorticoids for severe symptoms

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