Anti-IgE-antikörper und spezifische immuntherapie (SIT)

For patients with a confirmed association between allergic sensitization and disease (allergic rhinitis or asthma), SIT is indicated as the only current treatment option with curative capabilities. However, the application of SIT is limited by the relative high risk for severe side-effects and the possibility of weak or delayed efficacy especially for patients with severe allergic asthma. Therefore a combination of omalizumab, a monoclonal anti-IgE antibody, and SIT might be useful for the treatment of allergic diseases. There are now published three clinical studies, which demonstrated consistently that the combination of "active immunization" with standardised allergen extracts (SIT) and "passive immunization" with anti-IgE antibody (omalizumab) was superior to SIT alone in reducing symptoms and rescue medication use in patients with allergic rhinitis and in patients with moderate allergic asthma and comorbid allergic rhinitis. Moreover, pre-treatment with omalizumab prior to an intensified rush immunotherapy compared to SIT alone significantly decreased the otherwise high rates of allergic side effects, including anaphylaxis reactions, in patients with ragweed-induced allergic rhinitis. Conclusion: Combination of omalizumab with SIT for treatment of patients with allergic is safe and reduced symptom load in a statistically significant and clinically meaningful manner. The clinical implication of these findings is that also patients with moderate to severe allergic asthma pretreated with anti-IgE might prospectively benefit from a SIT as a causal treatment option.