Severe winter asthma exacerbations can be prevented by omalizumab, but there is no carryover effect

• Published in: Journal of allergy and clinical immunology Vol. 139; no. 2; pp. 703 - 705.e4
• Main Authors: Sly, Peter D, Varghese, Julie, Noor, Farhana, Tang, Mimi L K, Laing, Ingrid, Oo, Steve, Prastanti, Franciska, LeSouef, Peter N, Holt, Patrick G
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.02.2017
• Subjects: Adolescent; Asthma; Asthma - epidemiology; Asthma - immunology; Asthma - pathology; Asthma - prevention & control; Child; Epidemics; Female; Humans; Infections; Male; Omalizumab - administration & dosage; Omalizumab - adverse effects; Seasons; Severity of Illness Index; Studies; Viral infections; Winter
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2016.07.035

Exacerbations in school-aged children have been associated with sensitization to aeroallergens, particularly severe exacerbations requiring hospitalization, in which up to 90% of the affected group is atopic and has a viral infection.1 This apparent comorbidity is the subject of ongoing controversy, but recent studies have provided a plausible and testable hypothesis that might explain how atopy contributes to the exacerbation process.1 Notably, cross-linking of high-affinity IgE receptors (Fc[epsilon]RI) on plasmacytoid dendritic cells2 and myeloid dendritic cells3 of atopic subjects at airway mucosal infection sites, leading to attenuation of type 1 interferon production and enhancement of proinflammatory TH2 cytokine production, respectively, markedly amplifies local inflammation.1-3 This amplification process is IgE dependent, and hence blocking of available IgE during winter periods, which are at high risk for viral infection, might protect against these events.1 Several recent studies support this general concept.