OMALIZUMAB IN ASTHMA MANAGEMENT: FROM GUIDELINES TO PRACTICE

Abstract

Severe asthma remains a high-burden condition in adults, driven by heterogeneous endotypes that require phenotype-directed add-on therapy after optimization of inhaled treatment, adherence, comorbidity control, and trigger mitigation. Omalizumab, a humanized monoclonal antibody targeting immunoglobulin E (IgE), is an established biologic option for adults with severe allergic (IgE-mediated) asthma, positioned by major international strategies and society guidelines as an add-on therapy when standard high-dose inhaled corticosteroid/long-acting ẞ2-agonist based regimens fail to achieve control. Mechanistically, omalizumab binds circulating free IgE and reduces IgE-FcɛRI signaling by downregulating high-affinity IgE receptors on key effector cells, thereby attenuating allergen-driven mast cell, basophil activation and downstream type 2 inflammation. Evidence from randomized trials and real-world studies supports clinically meaningful reductions in exacerbations, improvements in symptom control and quality of life, and steroid-sparing benefits in selected patients, with ongoing attention to safety signals such as rare anaphylaxis and post-marketing cardiovascular risk discussions. This review summarizes guideline recommendations, patient selection, dosing and monitoring principles, and practical implementation steps tailored to adult practice, emphasizing response assessment and treatment optimization in routine care.