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Abstract
INTRODUCTION Due to daily hives with itch, sleeplessness, and unforeseen development of angioedema, chronic spontaneous urticaria significantly impairs quality of life, often for years. Its management is challenging. In most cases, H1-antihistamines are not effective. Although the disease is not characterized by specific IgE antibodies against allergens, the last decade demonstrated that neutralizing IgE by using the monoclonal anti-IgE antibody Omalizumab is safe and effective. Nevertheless, symptoms are not controlled by Omalizumab in approximately one-fourth of patients. AREAS COVERED This review is focused on Ligelizumab (QGE031), a next-generation non-triggering fully human monoclonal antibody, with higher affinity to IgE compared to Omalizumab. EXPERT OPINION In chronic spontaneous urticaria, subcutaneous Ligelizumab once per month for five months has shown a clear dose-response relationship with respect to symptoms. Superiority over Omalizumab was noted whereas the safety profile was similar. Most common side effects were injection site reactions. In the near future, results from phase 3 trials, two of them including more than 1000 patients each, are awaited. Having a higher affinity to IgE and being more effective than Omalizumab, Ligelizumab has the potential to free chronic urticaria patients from year-long daily annoying symptoms that did not respond to standard therapy as recommended by current guidelines.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School , Hannover, Germany
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2
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Poddighe D, Brambilla I, Licari A, Marseglia GL. Omalizumab in the Therapy of Pediatric Asthma. ACTA ACUST UNITED AC 2018; 12:103-109. [PMID: 29714140 DOI: 10.2174/1872213x12666180430161351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Eosinophilic asthma is driven by Th2 immune response and is usually characterized by the increase of total serum IgE levels and/or specific IgE that express single or multiple allergen sensitization. In such an immuno-pathological background, the anti-IgE therapy, namely omalizumab, found its main clinical utility and recommendation to treat severe asthma. OBJECTIVE In this mini-review, we summarized the most relevant immuno-pathological and clinical evidences supporting the use of omalizumab in the therapy of pediatric asthma. Furthermore, we provided the main practical points for its use in the therapeutic management of asthmatic children. METHOD Through the binding of serum free IgE, omalizumab impairs not only the effector phase of IgE-mediated asthma, but also affects the IgE biology and the related immune response, globally. Here, the history of omalizaumab has been shortly reviewed from its preclinical development to its clinical validation in pediatric asthma. Thus, recent patents regarding anti-IgE therapy have been discussed. CONCLUSION Omalizumab significantly improved the clinical management of severe and uncontrolled pediatric asthma; however, pre-treament IgE levels limited the use of omalizumab in some patients and the cost of the therapy is still relevant. Moreover, the optimal duration of the treatment with omalizumab in children has to be determined. Finally, the recent generation of a mutant IgE-Fc fragment being resistant to omalizumab binding might open further therapeutic applications, in addition to second generation anti-IgE antibodies.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan.,Dipartimento di Pediatria, Universita degli Studi di Pavia, Italy
| | - Ilaria Brambilla
- Dipartimento di Pediatria, Universita degli Studi di Pavia, Italy.,Dipartimento di Pediatria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Dipartimento di Pediatria, Universita degli Studi di Pavia, Italy.,Dipartimento di Pediatria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian L Marseglia
- Dipartimento di Pediatria, Universita degli Studi di Pavia, Italy.,Dipartimento di Pediatria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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3
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Hu J, Chen J, Ye L, Cai Z, Sun J, Ji K. Anti-IgE therapy for IgE-mediated allergic diseases: from neutralizing IgE antibodies to eliminating IgE + B cells. Clin Transl Allergy 2018; 8:27. [PMID: 30026908 PMCID: PMC6050685 DOI: 10.1186/s13601-018-0213-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022] Open
Abstract
Allergic diseases are inflammatory disorders that involve many types of cells and factors, including allergens, immunoglobulin (Ig)E, mast cells, basophils, cytokines and soluble mediators. Among them, IgE plays a vital role in the development of acute allergic reactions and chronic inflammatory allergic diseases, making its control particularly important in the treatment of IgE-mediated allergic diseases. This review provides an overview of the current state of IgE targeted therapy development, focusing on three areas of translational research: IgE neutralization in blood; IgE-effector cell elimination; and IgE+ B cell reduction. IgE-targeted medicines such as FDA approved drug Xolair (Omalizumab) represent a promising avenue for treating IgE-mediated allergic diseases given the pernicious role of IgE in disease progression. Additionally, targeted therapy for IgE-mediated allergic diseases may be advanced through cellular treatments, including the modification of effector cells.
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Affiliation(s)
- Jiayun Hu
- 1Department of Biochemistry and Molecular Biology, School of Medicine of Shenzhen University, Shenzhen, 518035 China.,2Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Jiajie Chen
- 1Department of Biochemistry and Molecular Biology, School of Medicine of Shenzhen University, Shenzhen, 518035 China
| | - Lanlan Ye
- 1Department of Biochemistry and Molecular Biology, School of Medicine of Shenzhen University, Shenzhen, 518035 China
| | - Zelang Cai
- 1Department of Biochemistry and Molecular Biology, School of Medicine of Shenzhen University, Shenzhen, 518035 China
| | - Jinlu Sun
- 2Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Kunmei Ji
- 1Department of Biochemistry and Molecular Biology, School of Medicine of Shenzhen University, Shenzhen, 518035 China
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4
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Nygaard U, Vestergaard C, Deleuran M. Emerging Treatment Options in Atopic Dermatitis: Systemic Therapies. Dermatology 2018; 233:344-357. [PMID: 29320765 DOI: 10.1159/000484406] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022] Open
Abstract
The pathogenesis of atopic dermatitis (AD) is multifactorial and intricate, and the clinical presentation of the condition varies greatly. Symptoms and severity depend on individual trigger factors and stage of the disease. The majority of AD patients are sufficiently treated with emollients in combination with existing topical or systemic therapies. Yet treatment failure with existing drugs and treatment options can be a significant clinical problem. New treatments are under development, and the majority of these new drugs focus on targeting a skewed immune response in AD. Novel therapeutic approaches, which target the pathways involved in the pathogenesis of AD, may provide a potentially more effective and less harmful approach to systemic therapy. These pharmaceutical agents are designed to narrowly modify or directly block a specific cellular signal or pro-inflammatory pathway. We review systemic drugs in the pipeline for AD. To make the review as current and pertinent as possible, we selected to focus on AD-related therapies available in the clinicaltrials.gov database with a first received date after January 1, 2014, up until May 31, 2017. We excluded therapies that could be categorized as either traditional Chinese medicine, herbal medicine, probiotics, histamine/leukotriene blockers, immuno-adsorption, or immunostimulants.
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Affiliation(s)
- Uffe Nygaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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Djukanovic R, Hanania N, Busse W, Price D. IgE-mediated asthma: New revelations and future insights. Respir Med 2016; 112:128-9. [PMID: 26577335 DOI: 10.1016/j.rmed.2015.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022]
Abstract
The central role of IgE in the pathogenesis of allergic asthma has been well established; recent research has brought to light further interesting findings regarding the effects of IgE and anti-IgE therapy. This symposium explored these recent revelations and provided new insights into the importance of IgE in allergic asthma.
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D'Amato G, Stanziola A, Sanduzzi A, Liccardi G, Salzillo A, Vitale C, Molino A, Vatrella A, D'Amato M. Treating severe allergic asthma with anti-IgE monoclonal antibody (omalizumab): a review. Multidiscip Respir Med 2014; 9:23. [PMID: 24735949 PMCID: PMC4113133 DOI: 10.1186/2049-6958-9-23] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Increased asthma severity is not only associated with enhanced recurrent hospitalization and mortality but also with higher social costs. Several cases of asthma are atopic in nature, with the trigger for acute asthma attacks and chronic worsening of inflammation being allergens inducing an immune, IgE mediated response. Anti-inflammatory treatments are effective for most of asthma patients, but there are subjects whose disease is incompletely controlled by inhaled or systemic corticosteroids and these patients account for about 50% of the healthcare costs of asthma. Omalizumab is a biological engineered, humanized recombinant monoclonal anti-IgE antibody developed for the treatment of allergic diseases and with clear efficacy in adolescent and adult patients with severe allergic asthma. The anti-IgE antibody inhibits IgE functions blocking free serum IgE and inhibiting their binding to cellular receptors. By reducing serum IgE levels and IgE receptor expression on inflammatory cells in the context of allergic cascade, omalizumab has demonstrated to be a very useful treatment of atopic asthma, improving quality of life of patients with severe persistent allergic asthma that is inadequately controlled by currently available asthma medications. Several trials have demonstrated that this therapy is well tolerated and significantly improves symptoms and disease control, reducing asthma exacerbations and the need to use high dosage of inhaled corticosteroids.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Speciality Hospital A. Cardarelli, Naples, Italy ; Committee of Ministry of Health on "Pollution, Climate and Respiratory Health, Naples, Italy ; Chairman Committee and Task Force on "Air pollution, climate change and allergic respiratory diseases" World Allergy Organization, Naples, Italy
| | - Anna Stanziola
- Division of Pneumology, Department of Respiratory Diseases, High Speciality Hospital "V.Monaldi" Naples and University of Naples Federico II, Naples, Italy
| | - Alessandro Sanduzzi
- Division of Pneumology, Department of Respiratory Diseases, High Speciality Hospital "V.Monaldi" Naples and University of Naples Federico II, Naples, Italy
| | - Gennaro Liccardi
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Speciality Hospital A. Cardarelli, Naples, Italy
| | - Antonello Salzillo
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Speciality Hospital A. Cardarelli, Naples, Italy
| | - Carolina Vitale
- Division of Pneumology, Department of Respiratory Diseases, High Speciality Hospital "V.Monaldi" Naples and University of Naples Federico II, Naples, Italy
| | - Antonio Molino
- Division of Pneumology, Department of Respiratory Diseases, High Speciality Hospital "V.Monaldi" Naples and University of Naples Federico II, Naples, Italy
| | | | - Maria D'Amato
- Division of Pneumology, Department of Respiratory Diseases, High Speciality Hospital "V.Monaldi" Naples and University of Naples Federico II, Naples, Italy
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Nonaka M, Sakitani E, Yoshihara T. Anti-IgE therapy to Kimura's disease: a pilot study. Auris Nasus Larynx 2014; 41:384-8. [PMID: 24406057 DOI: 10.1016/j.anl.2013.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
Kimura's disease is a chronic disease that is characterized by subcutaneous granuloma of soft tissues in the head and neck region, increased eosinophil counts and high serum IgE levels. It is thought to be an IgE-mediated disease. Omalizumab, a monoclonal antibody, has recently been suggested as a potential new systemic treatment for IgE-mediated diseases, based on its efficacy in treating asthma and allergic rhinitis. We report a study of three patients with Kimura's disease who received anti-IgE (omalizumab) treatment. All patients were treated with a fixed schedule of eight cycles of omalizumab 300mg, administered subcutaneously at intervals of 2 weeks. The size of tumorous regions was evaluated by MRI at base line and after 4 months of treatment. Blood samples were taken every month. In each of the patients, the size of tumorous regions and the peripheral blood eosinophil and basophil counts were all decreased after the treatment. These results suggest that omalizumab may be valuable for treatment of Kimura's disease.
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Affiliation(s)
- Manabu Nonaka
- Department of Otorhinolaryngology, Tokyo Women's Medical University, School of Medicine, Japan.
| | - Eri Sakitani
- Department of Otorhinolaryngology, Tokyo Women's Medical University, School of Medicine, Japan
| | - Toshio Yoshihara
- Department of Otorhinolaryngology, Tokyo Women's Medical University, School of Medicine, Japan
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Abstract
Asthma is a chronic inflammatory disease of the airway that leads to airway obstruction via bronchoconstriction, edema, and mucus hypersecretion. The National Asthma Education and Prevention Program has outlined evidence-based guidelines to standardize asthma therapy and improve outcomes. The initial recommendation of choice for persistent asthmatic patients is an inhaled corticosteroid (ICS). Long-acting beta-2 agonists in combination with ICS, oral corticosteroids, leukotriene modifiers, and anti-IgE therapeutic options can be considered for patients with persistent or worsening symptoms. Many novel therapies are being developed, with an emphasis on anti-inflammatory mechanisms, gene expression, and cytokine modification.
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