Omalizumab reduces bronchial mucosal IgE and improves lung function in non-atopic asthma

Abstract

Background

Bidirectional Mast Cell–Eosinophil Interactions in Inflammatory Disorders and Cancer

“…Concordantly, serum tryptase was reported to decrease under omalizumab therapy in two mastocytosis patients, but it remained unchanged in two other patients (142). A recent study performed on 18 non-atopic asthmatic patients showed improved lung function and reduced total bronchial mucosal IgE + cells in bronchial biopsies, but not changed total MCs, plasma cells, B lymphocytes, eosinophils, and plasmablast (143). A pooled analysis of five randomized, double-blind, placebo-controlled trials demonstrated that the reduction of serum-free IgE by omalizumab was associated with a reduction in peripheral eosinophil counts in patients with moderate-to-severe asthma receiving moderate-to-high doses of glucocorticoids [see Stokes in this issue and Ref.…”

Omalizumab could be effective in children with severe eosinophilic non‐allergic asthma

“…6 Another randomized trial was carried out in 18 non-atopic asthmatics who underwent bronchial biopsies before and after 12-14 weeks of treatment, which also showed that omalizumab improves lung function, despite withdrawal of conventional therapy; biopsies highlighted reduced bronchial mucosal IgE mast cells after treatment. 7 Of note, there was no significant decrease in median total eosinophils. 7 Our results suggest that children with severe eosinophilic nonallergic asthma with an associated elevated total serum IgE and, probably, nasal polyposis could be better responders to omalizumab than children without these features.…”

“…7 Of note, there was no significant decrease in median total eosinophils. 7 Our results suggest that children with severe eosinophilic nonallergic asthma with an associated elevated total serum IgE and, probably, nasal polyposis could be better responders to omalizumab than children without these features. This is in accordance with previous reports 8 where omalizumab was shown to be effective in nasal polyposis, regardless of the atopic status.…”

Targeting immunoglobulin E in non-atopic asthma: crossing the red line?

“…In this issue of the European Respiratory Journal, PILLAI et al [6] present results from a small study examining the effects of anti-IgE treatment in severe non-atopic asthma. In this proof-of-concept study, omalizumab therapy reduces IgE expression and IgE sensitisation of target cells within the bronchial mucosa while exerting a favourable effect on lung function in the short term, as assessed by changes in forced expiratory volume in 1 s (FEV1).…”

“…Therefore, it is important to review each patient meticulously and regularly and provide personalised and targeted treatment. Studies, such as the one performed by PILLAI et al [6], demonstrate that unexpected effects may be shown by medications used outside of their specified recommendations. This is important for research; however, it is not acceptable in clinical practice, unless further evidence is provided by large conclusive studies.…”