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Omalizumab (Xolair) is a medicine approved by the U.S. Food
and Drug Administration (FDA) for use in people age 12 and older with moderate
or severe persistent
asthma. It should be used only after first-line
treatments (such as corticosteroids and long-acting beta2-agonists) have
failed. Omalizumab is much more expensive than any of the conventional
treatments for asthma, and its role in asthma treatment is not clear.
Omalizumab works by blocking immunoglobulin E (IgE) from attaching to
allergens. When IgE attaches to an allergen, it sets
off a process that eventually leads to the symptoms of an
Initial studies show
that omalizumab reduces asthma episodes, improves
peak expiratory flow (PEF), reduces the need for other
medications, and reduces emergency room visits and hospitalization.1 But it has been studied only in people with positive skin
tests to indoor allergens such as
animal dander, cockroaches, and molds.
Omalizumab is injected, and the dose is determined by a person's body
weight and IgE level.
Omalizumab appears to be effective in people
Omalizumab can be considered in people who meet the above
criteria and whose asthma is not well controlled after using inhaled
corticosteroids and long-acting beta2-agonists or
leukotriene pathway modifiers for 3 months. People who use oral or injected
(systemic) corticosteroids or who require high doses of inhaled corticosteroids
for daily control can also consider using omalizumab.
allergic reactions, including
anaphylaxis, are possible when taking omalizumab,
although this is rare. So people who get omalizumab are watched for 2 hours
after they receive their first 2 doses. They should also carry epinephrine
(EpiPen) in case they have an allergic reaction after omalizumab
Rosenwassser LJ, Nash DB (2003). Incorporating
omalizumab into asthma treatment guidelines: Consensus panel recommendations.
Pharmacy and Therapeutics, 28(6): 400–410.
February 13, 2011
E. Gregory Thompson, MD - Internal Medicine & Rohit K Katial, MD - Allergy and Immunology
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