Influence of Omalizumab on Allergen-Specific IgE in Patients with Adult Asthma.

BACKGROUND: Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, inhibits the binding of circulating IgE to mast cells and basophils, resulting in fewer episodes of airway inflammation, asthma symptoms and exacerbations in patients with severe allergic asthma. Treatment of patients with asthma using omalizumab increases serum total IgE (tIgE) levels. However, little is known about the influence of omalizumab on allergen-specific IgE (sIgE). METHODS: tIgE and sIgE in 47 adult patients with severe asthma were measured with a fluorescent enzyme immunoassay (ImmunoCAP-FEIA) before and after omalizumab treatment. RESULTS: Treatment with omalizumab increased tIgE and sIgE levels. The increases in sIgE by class category after omalizumab treatment were positively correlated with baseline sIgE positivity before treatment. The mean changes in sIgE levels after omalizumab treatment were also correlated with baseline sIgE levels before treatment. The mean changes in tIgE levels were positively correlated with the mean changes in IgE levels against Dermatophagoides pteronyssinus, crude house dust, Japanese cedar and moth. Omalizumab markedly influenced the negative-to-positive seroconversion rate for IgE against Japanese cedar (30.8%), Candida (29.0%) and moth (28.0%). Finally, all patients with negative-to-positive seroconversion for Japanese cedar-specific IgE had cedar pollinosis before beginning omalizumab treatment. CONCLUSIONS: The changes in sIgE levels after omalizumab treatment may be dependent on the baseline sIgE levels. Our data may indicate the presence of undetectable but functional sIgE.

Longitudinal increase in total IgE levels in patients with adult asthma: an association with poor asthma control.

BACKGROUND: Immunoglobulin (Ig) E is well-known to play a critical role in allergic diseases. We investigated the association between longitudinal change in total IgE level and the asthma control in patients with adult asthma. METHODS: For this retrospective study, 154 patients with asthma aged 21-82 years were recruited from the allergy and pulmonary units of the Showa University Hospital. Data on longitudinal changes in IgE over the preceding 10 years were collected and logarithmically transformed. Associations between longitudinal change in IgE and clinical characteristics including asthma control test (ACT) score, asthma control, pulmonary function test, and antigen specific IgE, were assessed. RESULTS: Patients with increased IgE tended to have significantly higher mean age, more episodes of acute exacerbation within a year, lower ACT scores, and used oral corticosteroids more frequently than those with decreased or unchanged IgE. The prevalence of uncontrolled asthma was higher in patients with increased IgE than in those with decreased or unchanged IgE. Mean %FEV1 and FEV1% were lower in patients with increased IgE than in those with decreased or unchanged IgE. Moreover, the prevalence of Aspergillus-specific IgE was higher in patients with increased IgE than in those with decreased or unchanged IgE. CONCLUSIONS: These data suggest that a longitudinal increase in total IgE is associated with both poor asthma control and Aspergillus-specific IgE in patients with adult asthma.

[Assessment of climates affecting the control of bronchial asthma].

Pediatric patients with asthma are known to be exacerbated in autumn. On the other hand, there were few reports about the seasonal change of asthma control in the patients with adult asthma. In the present study, we conducted a questionnaire survey in 200 out patients with asthma to evaluate the climate which deteriorates asthma control. The patients whose asthmatic control was influenced by the specific climate were 141 (70.5%). The average age was younger and the percentage of moderate to severe was higher in the group whose asthma control was influenced by the specific climate than in the group whose asthma control was not influenced. The climate chosen the most as an inducer of asthma exacerbation was autumn, and the less was summer. Regarding to the severity, mild patients were tend to deteriorate in autumn, and moderate-to-severe patients were in winter. Meanwhile, the most climate chosen by the patients who had an obstructive ventilator disorder was winter, and the most climate chosen by the patients who did not have was autumn. These findings suggest that patients with asthma are influenced the most in autumn and severe asthma patients are in winter.