Immunoglobulin-E and anti-IgE treatment in lung disease.

A highly specific monoclonal antibody binding IgE (anti-IgE/omalizumab) has made it possible to determine the immunopathogenetic role that this reaginic antibody plays in human allergic disease. It is clear from recently completed studies that IgE is essential to the full generation of early and late asthmatic responses in human bronchoprovocation trials. Importantly, anti-IgE treatment of severe asthma disease significantly improves symptoms and reduces exacerbation episodes. Elevated serum levels of IgE are prominent in the clinical presentation of allergic bronchopulmonary mycoses and IgE-mediated Type I hypersensitivity reactions are of fundamental importance to the immunopathogenesis of allergic bronchopulmonary aspergillosis. Although the role of IgE in mediating immunity to helminth parasites is considerably less clear, it is safe to conclude that the overall balance of evidence does not support a primary role for IgE in host protection with regard to schistosomiasis and strongyloidiasis.