By S.H. Arshad, K. Suresh Babu, Stephen Holgate
Little new has been brought into the armamentarium for bronchial asthma treatment within the final thirty years except advancements in b2-adrenoceptor agonists, corticosteroids and cysteinyl leukotriene antagonists. notwithstanding, the advent of a completely humanised monoclonal antibody to immunoglobulin E (IgE) (omalizumab), should still offer a brand new approach of treating allergic problems, with results that stretch past a unmarried affected organ and tissue. the right function of this new agent in therapy directions might want to be rigorously evaluated, yet its transparent efficacy and safeguard supply a robust assertion in regards to the value of IgE around the complete spectrum of allergic ailment. This pocketbook offers an illustrative precis of the position of IgE within the pathogenesis of bronchial asthma and allied allergic issues, in addition to the results of anti-IgE remedy within the administration of those stipulations.
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Additional resources for Anti-IgE Therapy in Asthma and Allergy
IL-4 and IL-13 promote the class switch to IgE, while IFN-γ inhibits this. Under the influence of IL-4 and IL-13, class switching to IgE occurs that brings together the VDJ gene and the Cε region, allowing a looping out and deletion of the intervening C genes. 21 22 Th2 cell – IFN-γ + B-cell – IgE/CD23 IL-4 IL-13 + IL-4 IL-13 NK cell IgE class switch IL-4 IL-13 + B-cell Mast cell IgE/FcεRI Plasma cell IgE Figure 12 Th2 cells provide signals for IgE production through IL-4 and IL-13. When the surface bound IgE is cross-linked by antigen, these cells express CD40L and secrete IL-4, which in turn stimulate IgE isotype switching, producing more IgE.
In severe asthma (steroid dependent/steroid insensitive), immunosuppressive drugs such as methotrexate and cyclosporin could be used. Regular monitoring is required and they should only be used under the supervision of an asthma specialist. They are useful as regular, adjuvant therapy to inhaled steroids in moderate persistent asthma and are particularly effective for nocturnal symptoms. The therapeutic index of theophylline is low, and serious side-effects such as seizures, tachyarrhythmias and central nervous system stimulation can occur with high doses.
A recent report suggests that, in non-atopic individuals, asthma is more common if their serum total IgE is high. Evidence against the role of IgE Some investigators have not been able to find an association between total or specific IgE and the pattern of asthmatic responses following allergen inhalation, and suggest that the role of non-IgE (T-cell-directed) processes may be important, especially in the late asthmatic response. In a recent meta-analysis, it was suggested that less than 40% of the population attributable risk for asthma could be accounted for by atopy.
Anti-IgE Therapy in Asthma and Allergy by S.H. Arshad, K. Suresh Babu, Stephen Holgate