Anti-immunoglobulin E monoclonal antibody administered with immunotherapy

Despite both efficacy and immunotolerogenic effects, many clinicians still are reluctant to use allergen-specific immunotherapy (SIT) because of the potential for acute allergic reactions. The anti-immunoglobulin E monoclonal antibody, omalizumab, is approved by the U.S. Food and Drug Administration for the treatment of moderate-to-severe allergic asthma and has proven to be a relatively safe agent. Knowledge of the distinct immunologic changes elicited by allergen SIT and omalizumab has established a rationale for investigation into their combined use for the management of allergic diseases. This review summarizes two investigative studies examining the safety and efficacy of the combination of omalizumab + allergen SIT for the treatment of allergic rhinitis. Both studies show that the combination of omalizumab and allergen SIT confer added efficacy to either treatment alone. Pretreatment of patients with omalizumab before rush allergen immunotherapy also showed added safety to rush immunotherapy with the prevention of acute allergic reactions. Results thus far provide the opportunity to develop strategies using omalizumab pretreatment to enhance the safety and efficacy of allergen-immunotherapy to treat a wide variety of allergic diseases.