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i thought this might be of interest.

Meryl

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abst

ract & list_uids=16541965 & query_hl=7 & itool=pubmed_docsum

Allergy Asthma Proc. 2005 Nov-Dec;26(6):435-9.

Unanswered questions and warnings involving anti-immunoglobulin E therapy

based on 2-year observation of clinical experience.

Lanier BQ.

Department of Pediatrics, University of North Texas, Fort Worth, Texas 76132,

USA.

The relatively rapid development and deployment of a clinically useful

monoclonal antibody omalizumab has produced a number of questions still not

answered

despite massive research and many clinical trials. The mechanism of action as

down-regulation of FceR1 receptors in the presence of low free immunoglobulin

E (IgE) is incomplete. Some severe allergic asthmatic patients respond almost

immediately, others take months, and some never respond. No accounting for

the possible antigen sweeping by the complexes of IgG-IgE has been reported.

Skin tests may remain positive for much longer than reported, raising the

possibility of anaphylaxis with concomitant specific immunotherapy. Two cases of

anaphylaxis to specific immunotherapy while being " covered " with anti-IgE are

reported. Total IgE levels do not always rise as expected, six cases of static

IgE

levels in responders are reported. Total IgE levels do not dependably predict

usefulness. Current guidelines for anti-IgE use in asthmatic patients may

require reexamination as data from broad clinical experience are gathered.

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