Omalizumab
The trade name for this medication is Xolair.
The IgE antibody plays an important role in the development of asthma and allergies. It is important by initiating the immunologic response of mast cells. Studies have shown that serum IgE levels correlate with positive skin tests to aeroallergens, airway hyperreactivity and the prevalence of asthma.
Description
Omalizumab is a recombinant humanized monoclonal antibody. It binds to free IgE in the blood stream and forms an immune complex that cannot interact with the IgE receptors (FceRI and FceRII) on major allergy cells. Since IgE cannot bind, priming and degranulation of basophils or mast cells is blocked and the IgE-mediated inflammatory response is reduced. Omalizumab also seems to down regulate the FceRI receptor on basophils making less of these receptors available for binding IgE.
Dosing
Omalizumab is given as a subcutaneous injection to persons that are shown to be allergic by positive skin tests or ImmunoCap and who have and total IgE level between 30 IU/ml – 700 IU/ml. It is administered every 2-4 weeks depending weight and total IgE level.
ANTIHISTAMINES
Antihistamines may have some beneficial effects in the treatment of asthma. Their benefits, however, are very small compared with more established medications. Therefore, antihistamines are not recommended specifically for asthma treatment. Many individuals with asthma may experience symptoms of nasal allergy for which antihistamines are very helpful.
Common antihistamines:
Benadryl
Atarax
ChlorTrimeton
Vistaril
Allegra
Claritin
Zyrtec
Xyzal
Clarinex
Side
Effects
The most
common side effect of classic antihistamines is drowsiness. Other side
effects include dry mouth and eyes, stomach upset and decreased urination.
The side effects are rarely seen with second generation antihistamines.
Available
Forms
The medications are taken orally, in pill, capsule or liquid forms. Some antihistamines are available for injection.
Indications
for Use
These
medications are indicated primarily for the treatment of allergic rhinitis to
reduce runny nose, sneezing and itching. It often necessary to treat
nasal allergies in patients with asthma.
Contraindications and
Precautions
Because
many antihistamines cause drowsiness, they should be used cautiously in
combination with other sedating medicines and should not be taken with
alcohol. Antihistamines may worsen certain forms of glaucoma and may lead to
decreased urination in men with enlarged prostates.
ALTERNATIVE
MEDICATIONS FOR ASTHMA
The vast majority of
patients with asthma can be controlled with established conventional therapy.
Alternative therapy should be considered only after consultation with an
asthma specialist and after the following criteria have been met:
1.
The diagnosis of asthma is firmly established.
2.
All causative and contributory factors have been established and corrected.
3.
Adherence to conventional medications has been achieved.
Some alternative
medications include:
Colchicine
Cyclosporine
Cytotoxic therapy
Dapsone
Gold therapy
Macrolide antibiotic
Methotrexate
Hydroxychloroquin
intravenous immunoglobulin
Lidocaine-nebulized
Daily oral steroids
The use of these alternative medications is also quite limited due to their
potential toxicities and, in some cases, their high cost.