Mizuma Hiroko, Tanaka Akihiko, Uchida Yoshitaka, Fujiwara Akiko, Manabe Ryo, Furukawa Hitomi, Kuwahara Naota, Fukuda Yosuke, Kimura Tomoyuki, Jinno Megumi, Ohta Shin, Yamamoto Mayumi, Matsukura Satoshi, Adachi Mitsuru, Sagara Hironori
Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Int Arch Allergy Immunol. 2015;168(3):165-72. doi: 10.1159/000442668. Epub 2016 Jan 21.
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).
tIgE and sIgE in 47 adult patients with severe asthma were measured with a fluorescent enzyme immunoassay (ImmunoCAP-FEIA) before and after omalizumab treatment.
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.
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.
奥马珠单抗是一种抗免疫球蛋白E（IgE）单克隆抗体，可抑制循环IgE与肥大细胞和嗜碱性粒细胞的结合，从而减少重度过敏性哮喘患者气道炎症、哮喘症状和病情加重的发作次数。使用奥马珠单抗治疗哮喘患者可提高血清总IgE（tIgE）水平。然而，关于奥马珠单抗对过敏原特异性IgE（sIgE）的影响知之甚少。
采用荧光酶免疫测定法（免疫化学发光法，ImmunoCAP-FEIA）检测47例成年重度哮喘患者在奥马珠单抗治疗前后的tIgE和sIgE水平。
奥马珠单抗治疗可提高tIgE和sIgE水平。奥马珠单抗治疗后按类别划分的sIgE增加与治疗前基线sIgE阳性呈正相关。奥马珠单抗治疗后sIgE水平的平均变化也与治疗前基线sIgE水平相关。tIgE水平的平均变化与针对尘螨、粗屋尘、日本柳杉和蛾的IgE水平的平均变化呈正相关。奥马珠单抗显著影响针对日本柳杉（30.8%）、念珠菌（29.0%）和蛾（28.0%）的IgE的血清学阴转阳率。最后，所有日本柳杉特异性IgE血清学阴转阳的患者在开始奥马珠单抗治疗前均患有日本柳杉花粉症。
奥马珠单抗治疗后sIgE水平的变化可能取决于基线sIgE水平。我们的数据可能表明存在无法检测但具有功能的sIgE。
